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PROPERTY OF

ALEXANDER B. MOTT, M. D.

DEPOSITED IN

Mott Memorial. Llbrary.

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THE

EAST TENNESSEE

RECORD

MEDICINE AND SURGERY.

EDITED BY

FRANK A. RAMSEY, A. M., M. D.

APRIL, 1852.— No. 1.

KNOXVILLE:

PUBLISHED UNDER THE AUSPICES OF THE EAST TENNES-
SEE MEDICAL SOCIETY.

PRINTED AT THE REGISTER OFFICE.

1852.

I /

ctf

ORIGINAL COMMUNICATIONS.

Art. I. Importance of Medical Association and Medical Literature, 1

II. Typhoid Fever, 11

III. Premature Labor with Retained Secundines, 15

IV. Sulphuric Acid in Cholera Morbus and Diarrhea, 24
V. Oil Tiglii in Acute Rheumatism, 26

. VI. Report to Committee on Epidemics of Kentucky and Tennessee, 27

VII. Is Alcohol Removed from the System through the Lungs? 50

ECLECTIC AND SUMMARY.

Stewart on Quackery,

Retention of Placenta for Seven Months,

Parrish on Opinions and Services of Physicians,

Cleveland on Diarrhea andDyssentary,

Spontaneous Evolution,

Phosphate of Lime— Something Rich — Pass it Round,

A New Method of Preparing Powders for Use in Medicine,

Influence of the Hour of the Day on Births and Deaths,

Tobacco Smoke in Strangulated Hernia,

Cain on External Diuretics,

How to Destroy Taste of Cod Liver Oil,

Who First Amputated the Lower Jaw?

Hepatico-renal Circulation,

Tannate of Quinine in Intermttant Fever,

Compression of the Aorta in Uterine Hemorrhage,

EDITORIAL.
Salutatory,

Relations of the American Medical Association to the General Public,
Clerical Interference,
Drake's Discourses,
Mediea4 Society of East Tennessee,
Miscellany,

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56
57
59
60
63
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66
67
69
74
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77
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78

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95

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MH 1

FE3 17

THE EAST TENNESSEE

RECORD OF MEDICINE AND SURGERY.

APRIL, 1852.— No. 1.
ORIGINAL COMMUNICATIONS.

Art. I. — On the Importance of Medical Association and Med-
ical Literature: an Anniversary Address to the Physico-
Medical Society of New Orleans, delivered at the Medical
College, December 6, 1851, by E. D. Fenner, M. D.

[Published at the request of the Society.]

It has been remaked by a recent and able writer, that
"the study of medicine, venerable by all antiquity, yet in
itself is ever new."

Who that has attempted to unravel the mysteries of the
science in all its bearings, and to make himself master of its
wonderful powers, does not acknowledge the correctness
and force of this observation? Placed upon the stage of
terrestrial existence, the creature of surrounding circum-
stances and the sport of contending elements — ever striving
to live, yet ever in the midst of death, surely man becomes
the most interesting study of his fellow-man! And this
study, although permitted unto all who have a thirst for
knowledge, falls peculiarly within the province of the phy-
sician. His inquiries commence with the very elements
which mysteriously combine to form him — he pursues him
through the mutations he undergoes from the dawn of in-
fancy to the sun-set of age. He studies his anatomy, his

2 Dr. Fenner's Address.

physiology, his capacities in health and his infirmities in
sickness — all his relationships to surrounding objects, and
finally closes with his ultimate dissolution.

To use the language of one of the most eloquent of mod-
ern teachers: "Even in its infancy, when the world was in
darkness, was medicine a glorious science when compared
with its contemporaries, and its first professors were enno-
bled and exalted by its influence. As their mantles descend-
ed through a long line of illustrious successors, we see medi-
cine progressively expanding, and even when the night of
barbarism hung gloomily over the earth, we see its genius
triumphing over the surrounding darkness, and shining in
the east as a beacon to the ship- wrecked mind ot man; and
I trust I shall be able to prove to you, that, in our
own time, when the human mind has made such as-
tonishing advances, medicine has kept pace with her sister
sciences, and it is a gratifying reflection to think, that
among the most distinguished promoters of the collateral
sciences, physicians have ever held a commanding rank;
thus proving themselves foremost in knowledge, as they
have ever been in philanthropy, in private and public char-
ity, and in all good will to man."

Such, is a faint outline of the profession to which we
have devoted our lives, and of its rank among the avoca-
tions of enlightened man. It has called forth the first order
of talent in every age; and many, whose genius was first
awakened by its pursuit, have figured brilliantly in other
walks of life, as divines, as statesmen, as heroes, as patriots,
as poets and as philosophers. Its rightful domain has ever
been exposed to the invasion of charlatans and impostors,
and its noble attributes perverted to the vilest purposes;
yet there has ever been found among its votaries, enough of
genius and integrity to preserve it from utter prostitution.
It is to be lamented that the claims of those who have de-
voted their lives exclusively to the profession of medicinej
have never obtained their due consideration amongst the

Dr. Fenners Address. 3

distinctions ot government and society. Whilst the military
hero is crowned with the evergreen laurel, peans sung
to his name, and power, wealth and fame attend him in
his bloody career, the surgeon, whose godlike office it is to
guard his life and to heal the wounds he has inflicted, is too
often consigned to poverty and comparative obscurity.
Whilst the astute expounder of ill-devised laws, obtains hon-
or and emolument for darkening counsel and defeating the
ends of justice — whilst the interpreter of a mystic faith, as-
suming the sarcedotal robe, and claiming a mission from
Heaven, revels in luxury, and is almost worshipped by his
deluded followers, the physician who, with ceaseless toil
and care, visits the abodes of wretchedness and suffering,
staunching the bleeding wound and administering relief to
agonizing pain, is too often neglected and despised. Man-
kind seem to be altogether incapable of appreciating his
services. Yet he has his reward, in the inward conscious-
ness of doing good — the gratification of his benevolence —
the approbation of "the divinity that stirs within him;" all
which is far more delightful and more substantial than
the fleeting vanities of pomp and ceremony.

Such has ever been the usage of the world! Its greatest
benefactors have been doomed to martyrdom, whilst those
who have trampled upon its rights, scarred its physical
frame, and marred its moral countenance, have been idol-
ised and adored! But the philosophic study of the nature of
man, the operation of his organism in health and in dis-
ease, his origin, progress, and destination, possess an intrin-
sic charm of which it can not be divested. It is a study in
which we are all personally interested, and is surely one of
the noblest that can possibly occupy our minds.

It is with pride that we may refer to the rapid
advancement that has been made in medical science with-
in a comparatively recent period, and the beneficial results
that have followed. The people of our day not only live
better, but they live longer than those of ancient times.

4 Dr. Fenner's Address.

The value of human life has been greatly increased, as is
shown by the most correct investigation. Several terrific
diseases, that once decimated, even depopulated, whole
countries, are now shorn of their terrors, and almost extin-
guished; and many others, whose true nature was formerly
shrouded in mystery, and whose management was entrust-
ed to a blind empyricism, are now satisfactorily understood;
and if thousands still annually succumb to their ravages,
it is either because the victims have not demanded, in time,
the best ascertained means of relief, or these have been ap-
plied by incompetent hands. Knowledge on all subjects
has not only been greatly increased, but it has been more
generally disseminated, and bigotry, prejudice, and supersti-
tion are reluctantly yielding to the irresistable progress of
science and philosophy. Anatomy, Physiology and Pathol-
ogy have been cultivated with indefatigable zeal and ar-
dor; and Chimistry, a science unknown to the ancients,
has not only revealed to us the intimate nature of thera-
peutic agents, but has furnished us efficient antidotes
to the most deadly poisons. This wonderful and beautiful
science has doubtless done more for the enlightenment and
improvement of society than any other, and has advanced
to a degree of perfection altogether astonishing. The Di-
agnosis of diseases, a matter of vital importance — once de-
pendent on the deceptive instruction of outward and visi-
ble signs alone — has been placed by modern pathological
investigation upon a more rational basis. And prognosis,
too, although it can not be entirely divested of uncertainty,
is now .expressed with much more confidence than formerly.
Time would fail me to enumerate all the improvements
and benefits that have been effected by modern medical re-
search. Civilization can only guard us against and abate
circumstances that induce disease: it has no power to be-
stow physical immortality. But let us not withhold from
our venerable ancestors the tribute that is justly due them
or their valuable observations on the nature and treatment

Dr. Fennels Address. 5

of disease. When the world was in darkness and every
imaginable difficulty beset the path of medical science,
those mighty men, after long years of close observaticn, ac-
cumulated and have transmitted to us a valuable fund of
useful knowledge.

And now let me ask, who are the men in different parts
of the world that have done and are still doing so much for
science and humanity? Are they the isolated and secluded
individuals who have stood aloof from the society of their
brethren and pursued their investigations for the sordid pur-
pose of self aggrandisement alone! Are they those who have
withdrawn from the busy haunts of life, and relying upon
their own resources, scorned the efforts of their fellow-la-
borers in the same pursuit? No! they are men who have
caught inspiration from each other's genius — who have uni-
ted their efforts and aided each other — who have sifted and
examined each other's labors, correcting error and establish-
ing truth — who h ave encouraged each other in their self-
sacrificing ex ertions, and who have liberally and magnan-
imously proclaime d to the world their glorious discoveries.
In short, they are the members of medical societies, whose
genius and ambition have been awakened by collision with
their fellows — thus giving to each other a constant impulse
to exertion. The results of their united efforts have shed a
lasting benefit on mankind.

Such has ever been, and ever will be, the result of har-
monious and united action in the accomplishment of any
specific object. Man, isolated and alone, is but a feeble and
insignificant being; but when the sums of various talent
are combined, and concentrated, they may create monu-
ments that will survive the wreck of ages. Such has been
the origin of empires, and such the foundation of science,
religion and philosophy; indeed, of every institution that
has contributed to the elevation and happiness of mankind!
Such was the origin and establishment of our own glorious
republic, and the result verifies the maxim, "m union there is
strength"

6 Dr. Fenners Address.

I conceive the peculiar glory of modern times, and espe-
cially our own age, to consist in the numerous and powerful
associations that have been formed throughout the civilized
world, for the cultivation of science and the diffusion of
knowledge. The "Tree of Knowledge" is no longer consider-
ed the forbidden fruit that conceals under its delicious sa-
vor, the besom of destruction, but the blessed boon that ele-
vates the mind of man to a just conception of the attributes
of his Creator. Man, in a state of ignorance and barbarism,
is but little elevated above the beast of the field — (see the
poor savage groping his benighted path along the haunts of
civilization, like a lost or misplaced individual among the
rightful tenants of the earth,) — but when education and cul-
tivation have fully developed the wondrous powers of his in-
tellect, he lays the kingdom of nature under contribution,
chains the elements to his car, solves the mysteries of crea-
tion, and seeks the Great First Cause of all things, God in the
boundless regions of infinity and eternity!

This mighty stretch of godlike capacity is not attained
by the solitary efforts of isolated man. It results from the
genial influence of mind upon mind, and their associated
action in some grand pursuit. The pursuit to which
we have devoted our lives, the object of w r hich is to
meliorate the general condition of man, to enlarge his ca-
pacity for enjoyment, and to sooth and relieve the ills and
misfortunes incident to his frail nature, is, as I have before
remarked, surely among the noblest that ever engaged the
attention of the human mind. And it is this very pursuit,
perhaps above all others, that has derived so much benefit,
and been so greatly advanced by associated action. The
medical societies and colleges may certainly be ranked
among the most brilliant institutions of the age; and the re-
sults are that our means of preserving life have almost kept
pace with those wondrous inventions of destruction which, if
they were used as frequently as ancient arms, would render
war truly a scene of extermination.

Dr. Fenners Address. 7

But we have reason to rejoice that in our enlightened age,
the invention of these terrific engines of destruction has had
a tendency to lessen the chances as well as the horrors of
war. Men and governments now pause and reflect before
resorting to the this ultimatum. The claims of liberty and
justice are now enforced by more national means; and we
have the satisfaction to exercise our art mainly for the relief
of ills and calamities that are incident to the peaceful avo-
cations of life.

The first medical organization in the city of New Orleans,
of which we have any account, commenced in the summer
of 1817, when the Municipal Council, alarmed at the pro-
gress of an epidemic, Yellow Fever, which was then commit-
ting the most frightful ravages, appointed a committee to
call a meeting* of all the licensed physicians of the city, and
to confer with them respecting the best measures -of pro-
tection and relief. The call was promptly responded to,
and a succession of meetings which were characterized by
able and dignified discussions, led to the establishment of
the Medical Society of New Orleans, which was chartered at
the next meeting of the Legislature. This society was
chiefly composed of French physicians.

By an act of the Legislature, approved February 16th,
1820, the Physico-Medical Society of New Orleans was duly
incorporated, and was composed almost entirely of
English or American physicians. Both of these societies
were in operation at that period, and have left us a few re-
ports on Yellow Fever, which display great ability, and are
well worthy of being rescued from oblivion. We are in-
debted to our careful fellow-citizen, Dr. Barton, for such as
have been preserved, and have only to regret that they are
not more numerous. In these ancient reports, I find an en-
lightened enquiry into the origin and nature of Yellew Fe-
ver, with the most judicious instructions for its prevention.
If the sage counsels of these able men, imploringly urged
upon the municipal authorities, had been duly carried into

8 Br. Feancrs Address.

effect, thousands upon thousands of valuable ciu*vu* >.v.aid
have been rescued from premature graves, and our city
would now stand amongst the most prosperous and salubri-
ous in the world.

The respectable physicians of New Orleans have ever
been willing to give their counsel, as well as a large share
of their time and attention, to the improvement of the sani-
tary condition of the city, but have never met that encour-
agement and co-operation on the part of the municipal au-
thorities that was due to the importance of the object and ab-
solutely requisite for efficient action. But let us not be dis-
heartened. The time may not be distant when our ability to
do good will be more justly appreciated, and every facility af-
forded for successful operation. Our lot has been cast upon
the most interesting portion of the habitable globe. Here
Nature has spread out with a lavish hand, her wonderful re-
sources for the sustenacne and development of our race.
Around us a rich and virgin soil is annually fresh opened
by the plow-share, and under the genial influences of a
southern sun, yields plentiful harvests to the sweating brow.
Here flocks the immigrant from every land, defying the dan-
gers of an untried climate. But here, too, the most formidable
diseases prevail, as if in some degree to counterbalance
the abundant resources of life.

If we look around us and survey the extraordinary oppor-
tunities and advantages that our city presents for the culti-
vation of medicine and surgery, we can but feel a powerful
inducement to enter upon the task. We should make prop-
er use of these facilities, not only to improve ourselves, but
to stimulate medical inquiry throughout the south.

New Orleans is a peculiar place, and notwithstanding the
advantages with which it abounds, presents serious obstacles
to uniform and intense mental application. These obsta-
cles, however, depend more upon the habits of the people
than any thing pertaining to or inseparable from the locality
or climate. Notwithstanding the prevailing impression in

Dr. Fenner's Address. 9

regard to the enervating influences of a southern climate, I
am fully pursuaded that the energies of the mind may be de-
veloped and exercised to their greatest extent in this locality.
The greatest difficulties with which we have to contend
arise from the social habits of the citizens, the frequent in-
terruptions, and the pleasures and amusements that con-
stantly tend to draw us off from literary pursuits. The in-
fluence of these temptations upon the youthful mind may
challenge indulgence, but the precious time thus dissipated
maybe vainly sighed over in after years. I would by nol
means "fling a shade o'er young romance," or extinguish the
zest for youthful enjoyments, but I would have both temper-
ed with moderation, and mingled with the pursuit of useful
knowledge.

One word in relation to the literature of our profession,
and I shall have done. A moment's reflection will convince
you of its importance, and the necessity of sustaining it to
the best of our abilities. It is from this source we have ob-
tained all our knowledge of the past, as well as the discove-
ries and improvements of our own time. It is through this
medium alone that we can communicate with our fellow-
laborers in distant lands and shed abroad the lights of sci-
ence. Whatever there is of truth and science is to be found
in the books, or must be placed there, otherwise it will perish
with its temporary possessors. And no man can be an ac-
complished physician who is not well posted up in the lit-
erature of his profession. If we have been so fortunate as
to discover any important truth, and wish not to confine its
benefits to the narrow circle in which we move, it is our du-
ty to publish it; for we shall soon pass away, but our wri-
tings will endure.

Think not t here is nothing more to be done — no more
discoveries to be made— no use in noting the prominent
occurrences of the times. Much yet remains to be disco v^
ered; and he is most fully convinced of it who knows the
most. Each passing year makes fresh additions to our stock

10 Dr. Fenner's Address.

of knowledge. Every year differs from the past in its mete-
orology, which modifies in some degree the endemical dis-
eases of different localities, and demands a corresponding
modification of treatment. All these things aro. worthy of
record, and constitute in part the literature of the profession,
which will be more or less valuable according to the ability
and industry of the members. Medical literature in Amer-
ica is as yet comparatively meagre, but there are visible
signs of progressive improvement. We labor chiefly in the
great field of practicial observation, and leave to our more
learned brethren of the old world, the task of investigating
the depths of the science. It is our province to coWed facts,
and theirs to digest and generalise them. We labor in the
field — they in the closet and labortory. They proclaim what
is science — we test its truth.

Our researches and observations are best adapted to pe-
riodical literature, and it is most gratifying to witness the
rapid increase of these cheap and valuable publications in
our country. In 1843, there was not a single medical jour-
nal published south of Kentucky; now there are six, and'
they compare favorably with any in the country. Nothing
can more plainly show the progressive improvement of med-
ical science in the south, and I trust the spirit will not be
suffered to flag, until our medical periodicals, colleges and
societies be recognised as the best in America.

But let me not trespass any further on your patience, for
I feel that I have inflicted a punishment instead of an anti-
cipated pleasure. Had I properly considered the heavy la-
bors that were to devolve upon me during the year, and to
which I was fully committed, I should have declined the
honor of being your anniversary orator; but having impru-
dently accepted the appointment, I could but make the best
effort in my power, and throw myself on your kind indul-
gence for its glaring defects.

The Physico-Medical Society has now been in existence
upwards of thirty years, during which time it has occasion-

Hurley on Typhoid Fever. 1 1

ally suspended operation and reposed from its labors; but
I trust that henceforth its proceedings will have no in-
terruption, but go on from month to month and from year to
year, upheld by the talents and energy of its members, and
increasing in usefulness with the lapse of time.

For the last twelve months we have labored harmoniously
together, and I trust that the coming year is pregnant with
no calamity that will abate our ardor, disturb our friendship,
or diminish our number.

On motion of Dr. Copes, the thanks of the society were
voted to the orator, and a copy requested for publication.

Art. II. — Observations on Typhoid Fever, communicated by
Dr. W. R. Hurley.

The record of facts is the only sure method of testing the
value of the theories which have been advanced as to the
nature and treatment of Typhoid Fever, which disease has
elicited so much investigation and research within the last
half century. The pathological anatomist has fournished
us with a tolerably accurate view of the results of action
from the impress of the cause inducing Typhoid Fever, but
there is yet difference as to the proper treatment of the dis-
ease, with all the light of pathological truth beaming around,
there exists a wild confusion of hypothetical discrepancies,
even among the brightest lights of our noble profession.
These discrepancies can only be reconciled, as the thera-
peutical powers and physiological action of remedies are to
be estimated, by extensive observation; and it becomes the
duty of every practicial man to contribute, so far as oppor-
tunity will allow, to the attainment of these ends.

From 1846 to 1819, inclusive, I had under treatment an-
nually from 10 to 30 cases, the number increasing progres-

12 Hurley on Typhoid Fever.

si vely from year to year. In 1850 there occured 74 cases,
and in 1851, only 37, Of the 74 cases presenting during the
year 1850, there were 38 males, and 36 females, viz., set.,
5 under 10 20 30 40 50 60

5 15 13 4 1=38 Males.

2 22 7 1 3 1=36 Females.

Of the 74 cases, four were fatal: viz., three females, and
one male.

Case 1st, fatal. — A female set. 19. Had labored for
twelve months, previous to the febrile attack under a men-
strual derangement. She seemed to recover partially from
the fever, but was attacked with its worst sequala consump-
tion, and died three months and twenty days from the time of
the attack.

Case 2nd, fatal. — A female set. 45. Originally a mild at-
tack. A misunderstanding of the prescription, resulted in
excessive purgation, which produced collapse and death.

Case 3d, fatal. — A female set. 55. She set up, and smok-
ed her pipe, complained of fatigue, lay down and died sud-
denly. I had not visited her for more than a week previous
to her demise, and was not present when it occured, and,
therefore, I am unable to say anything as to her condition at
the time.

Case 4th, fatal. — A male set. 28. Was convalescent —
walked some three hundred yards on a warm day, relapsed,
and died within forty-eight hours.

Of the 74 cases, there were five which instead of the len-
ticular rose colored spots of Typhoid Fever, presented a
peculiar and thick eruption, resembling very much the erup-
tion of measles. There was no peculiarity in the access and
termination of the disease in these cases; they all recovered.

In most of the cases epistaxis occured in the early, and
but seldom in the latter stages of the diseases.

One of the cases, a male set. 12, was of such moderation,
that I discontinued my visits after an attendance of two
weeks. But a few days had elapsed when I was again call-

Hurley on Typhoid Fever. 13

ed to him on account of "an uncontrollable bleeding at the
nose," so termed by his friends. On my examining the pa-
tient, I found that I had general hemorrhagic tendency to
meet. He was bleeding from the nose and passing bloody
urine; and on every part of the surface of his body, was a
dark and slightly elevated eruption. The points of this
eruption varied in diameter from a few lines to an eighth of
an inch, the hue was very dark and their appearance resem-
bled that which is ordinarily disignatcd as "blood blister. "
One of these points havingbeen broken on the epigastrium,
was discharging blood freely, and was only stopped
by covering its surface with court plaster. His pulse beat
125 to the minute. J placed him in the semi- erect posture,
and stopped the epistaxes by plugging his nostrils with dry
cotton. The eruption continued about four days, gradually
disappearing, and with it the attending hemorrhagic dis-
charges. He recovered slowly and had no relapse.

A short time alter the recovery of the case just recorded,
I was called to see a patient of a neighboring practitioner.
The patient was convalescing under the care of his physi-
cian, when this hemorrhagic tendency was manifested — but
bleeding more freely from the nose than any other surface,
and presenting an eruption in every particular, similar to
the one which I have described. His physician had used
Acetate of Lead, internally and locally, but without effect.
He was very much prostrated by the loss of blood, and died
a few hours after I saw him.

During the year 1851, I had 37 cases under my charge,
20 males and 17 females, and aged as follows.
10 20 30 40 50 60
1 13 11 4 6 2=37.

All of these cases recovered, being for the most part mild
attacks — much more so than the attacks of the disease oc-
curing during the preceding year. The disease is very evi-
dently declining in this section, and preserves uniformity
with what I have observed to be true so far as relates to

14 Hurley on Typhoid Fever.

Scarlet Fever and Measles — much more malignant when
first appearing in a locality, than when beginning to decline
and disappear. On the question )f contagion, I have had
opportunity to make the following observations.

A gentleman of this county visited Georgia on business,
and a few days after his return home, was taken with Ty-
phoid Fever. He did not remember having seen any sick
person during his absence. His was, how r ever, the first case
of the immediate neighborhood. In about four months
eight members cf his family had the disease, and perhaps
four escaped. Visits were also made to this family, by other
families of the vicinity, and it is true that every family of
the neighborhood suffered more or less, though some were
attacked of whom it could not be positively affirmed that
they had been subjected to the influence of a contagious
principle.

A gentleman was living in a family at Madisonville, sev-
eral members of which had Typhoid Fever. Finally he
was attacked, and before he was compelled to take his bed,
he returned to his father's residence, ten miles distant, in the
country. After about three weeks, one of his brothers was
attacked, and in two weeks more two of his sisters. During
their illness, they were visited by a brother from a few miles
distant, a brother from Greene county, and a brother from Al-
abama. The one from Greene county was the only member
of the family who escaped an attack. They w T ere also vis-
ited by their neighbors, some of whom had the fever, but
the larger number were unaffected, yet in almost every fam-
ily in which the fever occurred, more than one were sick.

During the prevalence of this fever, but few cases of Re-
mittent Fever were observed; and of those few, all had a
Typhoid or low feature, and proved very refractory, unless
checked at a very early period after the first symptoms were
observed.

It is my design to communicate to a future number of the
Record, my views of the treatment of Typhoid Fever.

Philadelphia, Tenn., January 13, 1852.

Dixon on Premature Labor, 1 5

Art. III. — Case of Premature Labor, with Retained Secun-
dines, communicated by Dr. S. Howard Dickson.

In these days of Statistics, no apology will be required
from me for adding another to the list of cases, of a certain
accident already on record, even though I have no new
treatment to announce or theory to advocate. In fact, I do
not know but that experience, which gives force to rules al-
ready established, is more to be prised, or, at all events,
more cordially received, than testimony which would pull
down or weaken the existing theory, to build up some new
one instead.

On the twenty-ninth of April, 1851. Mrs, J., a lady about
thirty, the mother of several healthy children, sent to the of-
fice, where my partner, Dr. Ramsey, being too busy to visit
her, listened to her husband's account of her case. She was
then about three months gone with child, and had within a
few days noticed a slight discharge of florid blood from the
vagina. Dr. R. deemed it some accidental hemorrhage, as
it was unattended by any other symptom, and prescribed an
astringent accordingly. On the 7th of May, Mr. J. return-
ed, and as he stated that the bleeding, though diminished,
had not disappeared, 1 called to learn the particulars
more fully from the patient herself. m She only confirmed her
husband's account, however, and unwilling to press for an
examination per vaginum, I continued the treatment with the
addition of the application of cold water. On the 15th,
when I saw her again, there had been an increased discharge
of the same color and appearance, but as it was quite
checked again, I delayed an examination. On the 17th,
however, the hemorrhage showing itself again, I examined
per vaginum the os uteri, and found on the right of it an illde-
fined irregular tumor, its surface covered with a sort of gran-
ulations, whence the hemorrhage, fluid and arterial, proceed-
ed. I then came away, directing her to send to the office
for the necessary remedies.

16 Dixon on Premature Labor.

Next morning, I was summoned in great haste by her
husband, who announced that Ihe discharge had suddenly
become alarmingly violent; so much so that he feared she
would hardly survive, until we reached the house. Arri-
ving, I found that she had aborted, and the foetus was lying
in the bed, still undetached from the placenta, which had
not come away. On attempting to introduce my hand to ex-
tract, as the flooding was profuse, I discovered that the uterus
had contracted, and that its mouth was firmly closed.

Each effort to overcome the contraction was productive of
increased hemorrhage. Traction on the slender cord, along
side of which not even the point of one finger could beforc-
ad within the uterus, only ruptured it, without effecting any-
thing.

After steady, patient, repeated trials, as the patient's
strength was rapidly failing, I determined to desist, and turn
my attention to checking the discharges of blood, while } r et
her life might be saved. The blood had, by this time, pen-
etrated the bed, and dripped, drop by drop, on the floor. In
the bed, between her thighs it stood some two inches deep.
Her repeated sighing, constant nausea, the paleness of her
lips and face, and her sense of faintness proved the urgent
necessity that she should lose no more blood. Cloths
wrung out in cold water were placed over her abdomen
and introduced within the vulva. A dose of Camph. Spts.
and Ammon was administered, which she immediately vom-
ited. The straining in the act of vomiting caused an exces-
sive increase of the hemorrhage, and she swooned. On the
return of consciousness, she took a pill of Acet. Plumb,
and Opium, which also her stomach rejected, as in fact it
did every thing offered it, until nine in the evening. Choths,
soaked in strong astringent solutions, were introduced
into the vagina. Mustard Plasters, Creosote, everything
I thought likely to restrain the vomiting or the flooding
were in succession tried, without any effect, save to make
her vomit immediately, and increase the hemorrhage. At

Dickson on Premature Labor. 17

last she fainted again, and it seemed that she was destined
never to arouse from her syncope. When she did, after
long use of Ammonia, Brandy, &c, there was a perceptible
diminution of the stream from the vagina, and though she
vomited several times afterwards, there was no alarming re-
turn of the hemorrhage. Nothing seemed to give relief to
the distressing nausea from which she constantly suffered,
save cold wet cloths to the forehead.

The old ladies, who had mustered in great strength, insis-
ted on my removing the placenta, which, for the reasons that
as it was not within my power, and would have proved in-
stantly fatal, if it could have been done, I declined. And at
no time afterward did I observe such a state of the uterus as
would allow me to believe that extraction of the placenta
was practicable, or that a renewal of the effort to introduce
the hand into the womb would not be followed by dangerous
or even fatal hemorrhage. To satisfy the minds of her anx-
ious relatives, my partner being absent, I called on Dr. F. A.
Ramsey, to examine the patient, and assist me by his advice.
In consultation, he approved of the practice instituted, and de-
cided with me, in view of the slight hemorrhage still proceed-
ing from the tumor, the pale and exhausted appearance of the
patient, and the great gastric irritation, present, not to at-
tempt the manual or instrumental delivery of the placenta.
To check the last-mentioned symptom, he advised a large
dose of Hydr. Proto-Chlor. which was given with marked
advantage. This, with the occasional after use of calma-
tives and antacids, formed the whole treatment of the con-
stitutional symptoms, which I am free to confess, were very
distressing, though at no time alarmingly so. More or less
nausea, considerable prostration and anemia, and slight
pyrexia, persisted for several days, during which time a dis-
charge continued from the vagina, somewhat resembling
the ordinary lochia of lying-in women, but rather greater in
quantity and a little more offensive in smell. Frequent use
of dilute solutions of Acid. Pyrolig. seemed to [give great
c

18 Dickson on Premature Labor.

relief not only from the unpleasant odor, but also from
such constitutional disturbance, as must undoubtedly have
arisen from the presence of the putrefying placenta within
the uterus.

It seems to me that we, at the bottom of the ladder of
authority so much esteemed, and so worthy of esteem,
take a mischievous pleasure in arraying the occupants of
the upper rounds against each other. How constantly we
meet with the expression, "Authorities on this subject differ
much as to the proper practice." Take the present as an
example. Some high authorities insist on the immediate
removal of the placenta, always, at all hazards, I had almost
said at all events, under all conceivable circumstances.
Others, though not quite so urgent, have, like the former,
proposed and used instruments, hooks, forceps, &c, for its
extraction, when its manual delivery is impracticable. Oth-
ers seem to think it a question to be decided by the circum-
stances of each case for itself- And there remain some, who
like Puzos, prefer always leaving such cases to nature.

This author says, (I quote after Prof. Meigs, and translate
from Puzos,)

"This accident is not very dangerous; but it is very tedi-
ous; I have seen these oozings continuing from six weeks to
two months; and during all the time, in which the discharge
was so foetid, I have found these women afflicted with irre-
gular fevers and occasional nausea and restlessness."

Prof. Meigs, while he does not quite concur in Puzos'
passive expectant plan, declares, however, that he thinks
"that there is no danger in leaving such occurrences in
the hands of nature; and that it is better to do so than re-
iterate attempts to extract by force, that have perhaps al-
ready proved quite vain; especially, considering that there is
as great danger of exciting inflammation by those attempts,
as could be anticipated from the gradual maceration of
the ovum."

It may not be out of place to add here, that as the foetid

Dickson on Premature Labor — Remarks. 19

discharge grew less profuse, its bloody color returned, and
examination per vaginam, proved that though somewhat les-
sened in size by the contraction of the uterus, the tumor on
the os tincae retained its original appearance and character.
A few applications of the pencil of Nitr. Argent., however,
effected the entire removal of the tumor; and simultaneous-
ly, of course, the hemorrhage disappeared.

EEMAEKS .

Dr. Dickson's case well illustrates the fallacy of the opin-
ion so commonly entertained by the unprofessional, that any
person almost, can officiate as midwife, and the error of the
belief of many who practice medicine, that midwifery is the
easiest mastered of either of the practical branches which
employ the attention of medical men.

The unprofessional should know, and well appreciate the
fact, that tie difficulties which occur during the process of
labor, are, for the most part, comprised in the single and stu-
pendous difficulty, on the part of the obstetrician of correctly
apprehending the time and circumstances when it is proper not
to interfere and not to give assistance.

During our pupilage we were deeply impressed, and a
new train of thought was aroused, by a remark which has
influenced the whole course of our professional life, made by
the venerable Dudley, of Transylvania, and which is appro-
priate just here. "It is much easier to decide when than
when not to give medicine, or easier to decide when to ope-
rate than when to refrain from surgical manipulation." And
what but surgical are the duties discharged by the midwife?
Those practitioners who underestimate the importance of
extensive research and profound reflection as applied to ob-
stetricy, are generally pressing in their encouraging cry of
"bear down," prompt in the administration of uterine exci-
tants, quick to decide that instrumental aid is requisite, and
with ready alacrity apply the crushing lever, the forcing
forceps, or the more deadily craniotomy forceps and embry-

20 Dickson on Premature Labor — Remarks.

ulcia instruments. All of these have been devised by edu-
cated ingenuity, stimulated by necessity, and should never
be used except under the direction of an intelligence fully
qualified to estimate the demand of circumstances. General
principles must govern the physician and surgeon; no
definite or fixed rules of practice can be established which
shall quit him of the responsibility of thinking; of maturely
and reasonably considering every circumstance connect-
ed with the particular case under charge. And to correct-
ly appreciate such circumstances, as well as the general
principles under which the treatment of the particular case
would be classified, he must be intimate with the history of
many such cases reported by many different practitioners.
A legal gentleman once remarked: "We have too many case
lawyers." The reverse is too true with medical men. We
have too many who, depending on their knowledge of what
chey regard as fixed, unvarying laws, and on what they have
seen, (observed is too comprehensive a word to use in this
connection,) they refrain from that research into the features
of reported cases, which is the only true means by which
a practitioner can qualify himself to act promptly, properly,
and conscientiously.

But to the application. It is a general principle, that all
labors, premature or at full term, must terminate by the
placenta and membranes being thrown off or removed. Yet
there are exceptional cases, in which persevering efforts to
act in accordance with this general principle, would be pro-
ductive of the most unfortunate results. It is comparatively
an easy matter to introduce the hand into the womb, and
permit it to contract and expel both hand and placenta,
when the retention is dependant on atomy of the womb, or
want of uterine contraction, and it matters not, provided
there be no hemorrhage or other circumstance demanding
immediate action, whether the manual interference be insti-
tuted at the end of an hour after the birth of the child, as
Lea and Meigs direct, or as Collins says, "having waited for

Dhkson on Premature Labor — Remarks. 21

about two hours, and employed all those gentle means ordi-
narily recommended for its removal, but without effect, to
give assistance." But in those cases of retained secundines
dependent on that irregular contraction of the uterus, which
Churchill says "is seldom noticed in books and yet is of fre-
quent occurrence," and which consists of a firm, and in some
cases 'unyielding, contraction of the fibres of the cervix,
manual assistance is quite another affair. So far as system-
atic writers are concerned, this is one of those cases, in which
it is by far more difficult to deliver, than to write, "de-
liver by gently introducing the hand cone shape into the
vagina, and gently insinuate one finger after another, until
the contraction is overcome and the whole hand enters the
womb." The most skillful manipulation under such cir-
cumstances can but be hazardous; the learned touch should
tell the practitioner whether to proceed in any particular
case, without the fear of purulent absorption influencing
him to commit an act which otherwise he himself would
regard as violent. Of all the cases of death which have
occurred after a labor with retained secundines and been as-
cribed to the retention, we have but little doubt that inflam-
mation, excited by unwanted efforts to remove the placenta,
exerted an immense influence in producing the result. We
have seen more than one case of retained secundines, but
never but one of death which, by a possibility, could be as-
cribed to retention. In that case a very ignorant old mid-
wife had attempted for several hours to effect the delivery
of the afterbirth, and though putrefaction occurred, the pa-
tient had manifested before death all the evidences of inflam-
mation of the womb. Coincident efforts and conditions render
a definite conclusion quite difficult, under such circumstances,
but we believe that writers have placed too much stress on
the necessity of the removal of the secundines, at the expense
of the integrity of the tissues subject to disturbance by the
manipulation necessary to such removal. The teachings of
systematic writers tend to inculcate the opinion expressed

22 Dickson on Premature Labor — Remarks.

by Dr. Robertson, as reported in the "London Medical
Times," Oct. 25, 1851. He says: "It is clearly the duty of the
medical man to take away the whole of the placenta, be-
cause every medical man knows that if he does not, he consigns
the woman to certain destruction. * # # The whole of
the placenta should be removed, and if a medical man did
not do this, he did nothing — he did not do his duty."* He
was giving evidence at an inquest held upon the bod}' of a
woman supposed to have died from retention of a portion of
the placenta, the rest having been removed piecemeal, by an
obstetrician who was not qualified for the duties be assumed.
But thanks to the periodical press, we have enough influence
to lead the investigating, enquiring mind to adopt more cor-
rect precepts and more judicious practice. Thus the editor
of the Times,'Commenting on Robertson's evidence, says :
"The temerity of this assertion is not warranted by experience
nor by the opinions of the best accouchers. We have known
many instances in which decomposed portions of the placenta,
and putrid coagula, have passed a few days after labor, from
patients, who, according to this teaching, ought to be dead
and in their shrouds, but who are, on the contrary, living well,
and the mothers of healthy offspring." And a contributor
to the Times, (Nov. 8, 1851,) commenting on the testimony of
Robertson, says: "Surely such broad assertions, for whatever
purpose they are uttered, should not be allowed to pass
by unheeded." He then refers to two retentions in the
same female, in consecutive labors; "the woman required
nothing to forward convalescence which soon took place,
without evidencing any symptoms beyond what the most
ordinary confinement produces." And in the same number
of the Times, another contributor reports three cases as hav-
ing occurred in his practice, in which he thought best to leave
the placenta in whole or in part. He says: "In the ahove
mentioned cases, the life of the patients would have been sa-
crificed by any further attempts to remove the placenta."
In the British and Foreign Medical Review. July, 1842 #

Dickson on Premature Labor — Remarks. 23

page 236, Dr. Scholler records a case of retention of placenta
for eleven weeks. When it was thrown off, "it had not un-
dergone the slighest decomposition, was hard, surrounded
by a coating of fibrine, and shrunk to the size of half a
goose egg" The woman followed her usual occupation
until within a week previous to the expulsion of the retain-
ed mass, when the womb threw off, under the stimulus of
Ergot, "coagula mixed with fibrous and membranous mat'
ters, and having a very offensive odor." In the Retrospect,
No. 14, p. 286, a case is found, from Monthly Jour. Med. Sci-
ence, June, 1846, of a woman who was delivered, and the
placenta retained. "For three months there remained a slight
hemorrhage, with pains and a sense of weakness. Under
the stimulus of Ergot, the womb expelled a fleshy body, com-
pact, of a deep red color, having the form of the uterine cav-
ity. Her recovery was rapid and comp!ete.' , In the Amer.
Journal, for Nov., 1828, p. 224, and Nov., 1829, p. 231, a case
is republished from a foreign journal, of a dead child in which
purification had commenced. The placenta could not be
extracted. The cervix uteri closed, and the woman enjoyed
a perfect state of health till the following May, when slight
pains, and a sanguineous discharge appeared. After a short
continuance these symptoms subsided, and soon returned
again with more severity, effecting the expulsion of a pla-
centa, the presence of which in the uterus for so long a time
as four months, had been productive of no inconvenience.
And other cases might be cited which strongly sustain the
point which we desire to establish; such for instance as the
cases which have been recordecMbr the purpose of proving
that the placenta, when left in the womb, is frequently ab-
sorbed and without detriment to the economy. Indeed, we
very much doubt the validity of the received general princi-
ple, because it remains yet to be proven that the cases in
which death occurred, so terminated alone or directly from
the retention, rather than from efforts instituted for the re-
moval of the secundines, and injudiciously persevered in, at
the expense of the integrity of the tissues immediately in-
volved. — Editor Record.

24 Rogers on Cholera Morbus and Diarrhea.

Art. IV. — Sulphuric Acid in Cholera Morbus and Diarrhea.
Communicated by Dr. James Rogers.

Some time since I was somewhat though pleasantly sur-
prised, at the reported success, in communications to the
London Lancet, attending the use of Sulphuric Acid in Chol-
era and Diarrhea; and I determined to test its applicability
to such diseases at the earliest opportunity.

Since then I have several times had occasion to treat these
affections, and as yet have no reason to regret having re-
posed confidence in the truthfulness of the contributors to
the Lancet.

Two of the cases occurring in my practice, will, I think,
establish the fact, that the remedy is as efficient here as in
England.

I was called at an early hour, on the morning of the 10th of
December, to see Mr. D. who I was informed had been attack-
ed during the previous night with Diarrhea. I found him suf-
fering with severe griping pain in the stomach and bowels, and
forced to stool about every twenty minutes, vomiting at each
evacuation of the bowels. I could not learn the character of
the discharges which had been passed during the night, as
they had not been observed; they were now, however, con-
siderably mixed with blood and mucous. I had with me a
mixture composed of Dilute Sulphuric Acid, Co. Tinct. Car-
demon, of each, 2 drachms, and water b\ ounces. Of these I
immediately gave two table spoonsful or about one ounce,
and directed it to be repeated in table spoonful doses
after every operation. I remained some thirty minutes
after I had administered the first dose, and during that
time no discharge from the bowels or stomach occurred,
and the sickness and abdominal pain were very much re-
lieved. At my evening visit, at a late hour, I learned that
my patient had been to stool twice, and that the dischar-
ges were somewhat consistent, and more natural in color,
and destitute of any appearance of blood or mucous, and

Rogers on Cholera Morbus and Diarrhea. 25

had been passed without pain, nausea or vomiting. I called
to see him the next morning, but was informed by his family,
that feeling himself entirely relieved, he had gone to his
work as usual. The quantity of the mixture taken in all
was about 2J ounces. No other medicine whatever, was
used. He has had no symptoms of the disease since.

On the 12th of December, I was summoned to see Mr. R.
who is remarkably subject to attacks of Diarrhea, on being
exposed to cold damp weather. ' During the winter months,
he rarely escapes after getting hisfeet wet. The attacks
are usually attended with much abdominal pain and ten-
derness, and leave considerable debility of the stomach
and bowels. I had been in the habit of treating him
with Calomel and Opium, opiated injections, and Lye poul-
tices to the abdomen, but on this occasion I relied on the
Sul. Acid mixture. I found him at this visit, as usual when
attacked, with abdominal pain and tenderness, and each
operation attended with cramp of the stomach and bowels;
and when not at stool, suffering with nausea and inclination
to vomit.

I immediately gave two table spoonsful of the mixture,
which promptly allayed the nausea, and relieved the pain
and griping. I directed the repetition of the mixture in
doses of a table spoonful after each operation; but it was
unnecessary to repeat but once after which he was per-
fectly well. The debility of stomach and bowels which
had uniformly succeeded previous attacks, was not observed
at all; and the patient is confident that he was never before
so easily and so perfectly relieved.

Knoxville, Tenn., February 13, 1852.

26 Lenoir on Oil Tiglii in Acute Rheumatism.

Art. V. — Oil Tiglii in Acute Rheumatism. Communicated
by Dr. B. B. Lenoir.

The following case exhibits favorably the action ofCro-
ton Oil in Acute Rheumatism, and is presented as such to
the, readers of the Record, remarking that of course some
credit must be given to the adjuvants employed.

November 30, 1850.— W. C. B. requested me to visit his
daughter. Being already engaged for the day, I postponed
the visit, until the morrow, and received the following his-
tory of the case, for the purpose of forming an opinion, that
I might direct some remedies for application until the hour
of my visit.

Dialtha S. B. — set. 7. For four years has been subject
to attacks of severe pain in her left hip and thigh, which
always commences before falling or in cloudy weather, and
generally continues a week. The present attack commenc-
ed on the 23rd inst., is more severe than usual, and still gets
worse. This morning the hip was discovered to be consid-
erably swelled. She sleeps none, or very little.

I made the following prescription.

R. Oleum tiglii, gtt. 3.

Pil. Hydrarg. grs. 20, in pillula 4.

R. Pulv. Opii. grs. 2.

" Ext. Glyc. grs. 10, in chartul. 2.

R. Liniment, Vol. 1 ounce.
01. Terebinth. 2 drachms.
Tinct. Opii 1 drachm

S. One of the pills to be given en his return, and another
on the following morning.

One of the powders at bed time.

The Liniment to be frequently applied to the thigh.

December I, visited the patient, at 1 o'clock, P. M-, and
found her sitting in a chair, countenance cheerful, temper-
ament sanguine, no pain left, and swelling reduced; had slept
well during the night, the first good sleep in a week; the
pills had produced copious discharges in the evening and

Ramsey*s Report. 21

morning. No more medicine was deemed necessary, and
none was given. She h is remained well since,

1 am indebted for the use of Croton Oil in this disease to
Dr. Geo. L. Upshur, of Norfork, Va. See Med. Examiner,
1850, page 574. I have given it in one or two cases verging
on the chronic form, with less benefit; and in a few other
acute cases, in wffich it always has afforded relief.

Roane co., Tenn., February 13, 1852.

Report made to W. L. Sutton, M. D., Chairman of Commit-
tee on Epidemics of Kentucky and Tennessee, appointed by
the American Medical Association, Session 1851, by Dr.
Frank A. Ramsey.

[At the last session of the American Medical Association, held in Charles-
ton, S. C, the style and duties of the committees were changed, whether for
the better, remains to be proven, for changes, it has been said, are not always
improvements. In our humMe judgement, we think the Association should
take such s ; eps as will add to the value an I enhance the interest of the peri-
odical publications of the profe-sion, and from this source the committees
should obtain the materials of their reports, rejecting the little not worth
considering, and carefully estimating and classifying the much thus recorded
which merits preservation.

But the eh inge h isbaen mile, and we deem it to be the duty of every practi-
tioner of medicine to expedite, as far as he can, the attainment of the objects
for which the Association is laboring. Most certainly it is the duty of
the members of the Associ ition, and we think of every medical man, for
if he owes no allegiance to the Association, he owes something to the pro-
fession which has enabled him to support himself amongst men.

The committees of the present year addressed circulars to the mem-
bers of the medical profession, asking that information should be furnished
on the subjects on which they were to report. In answer to the circular
of the committee on the Epidemics of Tennessee and Kentucky, we prepared
the following tables, and forwarded them to the Chairman, Dr. W. L. Sutton,
of Georgetown, Ky., with the request that they should be returned. In his
letter returning them; he says: "It seems to me such papers are particular-

28 Ramsey's Report.

ly needed." We, therefore, publish them and hope that the physicians of
East Tennessee will see the .importance of preserving and reporting their
cases, with such comments and reflections, as circumstances or inclination
may prompt. — Ed. Record.]

Knoxville, Tenn., December, 22,1851.
Dr. W. L. Sutton — Dear Sir : An inflamed hand, caused
by putrid matter from the vagina of a woman who had been
delivered by a midwife, and who left the membranes behind,
has prevented me from attempting at an earlier date to com-
ply with your request and my duty. The lateness thus oc-
casioned will force me to be less precise than I would oth-
wise have been. I hope you will excuse me for making
tables of my own. The reason why I have done so you
will perceive, is the meagre number of cases of diseases
occurring in my practice, and mentioned in your table. And
you can from these best judge of the "atmospheric constitu-
tion" from month to month; for an actual Epidemic has
never, as I believe, occurred here. In an announcement is-
sued, during the year now about closing, by the Principal of
a Female Academy, it is asserted that "Knoxville has never
been visited by an Epidemic." The very fatal visitation of
1838, originated, undoubtedly, from local causes ; occa-
sionally, and at long intervals, a few cases of Measles have
been observed; Scarlet Fever has once or twice been
reported — but at the time, if it existed, it was confined to
one house; I have never seen a case of this disease in Knox-
ville since I located here in 1842; the "Black Tongue" pre-
vailed to a very limited extent, during the fall of 1843.
* During the summer of 1845, Typhoid Fever was re-
cognized by our practitioners, and since then it has been
observed to be the prevailing type — the old Remittent with
which all had become so familiar, only occasionally present-
ing. I have noticed within the present month that Quinine
is an effective agent, having been led to employ it, by the
very positive remissions which occurred in the cases of Pneu-
monia of children. It may be proper to state that while I re-
cognise the great advantage of physical signs, I admit their

Ramsey's Report. 29

inadequacy under many circumstances to perfect a know-
ledge of the seat and nature of diseased action; and par-
ticularly in children, the physical signs may or may not in-
dicate the state of the lungs. I, therefore, in connection with
other rational signs and symptoms, in all cases, but more
especially in children, take the circumscribed and persistent ,
though changeable, deep red flush of the cheek as indicative of
pulmonary inflammation.

I am very sorry that I can not furnish you with tables em-
bracing the whole year; but before the month of April, I
was not in the habit of noting the name of the disease or
the case of every patient; I recorded only such cases as
presented obscurity in manifestations or interest from in-
tensity or peculiarity or other extraneous circumstances.

APRIL,

1851.

DEATHS.

Diseases.

under 15

15 to 35

over 35

under 15

15 to 35

ov.35

M
1

Pneumonia,

Catarrhal Fever,

]

Remit. Fever,

do do

Rheumatism,

Constitutional Ir-

ritation and Fe-

ver from injury
to Knuckle,

Abscess Petrous —

following Ty-
phoid Fever,

Abscess Breast,

Constipation,
Colic,

w
w

' 2

1
1

3
1

Amenorrhsea,

Menorrhsea,

Induration and ul-

ceration of Vagi-

na ?nd Cervix,

Marasmus,

Hemoptysis,

1
30

Three of this total resided in the country — two transient visitors to town.

30 Ramsey's Report.

Pneumonia. — The case of Pneumonia occurring in the fe-
male, was complicated by the pressure of an enormous Goitre.
She was under care from the 1st to 16th inclusive. Bleeding,
Calomel, Tart. Emetic, Hyd. Potas. and Blistering, with Oil
Turpentine, Tinct. Assafcetida and Blood-root constituted the
resorts employed. It was truly a desperate case, and was
attended by another practitioner and myself, both being
summoned at the same time, though from the temporary
absence of my colleague in the case, I saw her first.

Remittent Fever. — The case of Remit. Fever which termin-
ated in death, was under my care from the 4th to the 16th in-
clusive. It was a gentleman aged about 38, who was in
search of a residence where he could live free from physical
and mental excitement, to prevent exaccerbating a disease of
the heart under which he had labored for several years. The
impulse ofthe heart was very great, being felt thumping al-
most as forcibly on the right side as the left, while a puffing
friction sound, like the 'scape of a steam-boat, could be heard
at any point of the thorax, and with the ear several inches
from the surface. He had been sick some two weeks before
I saw him. He was in ordinary health a vegetanarian,
and since his attack had frequently purged himself with
pills and Seidlitz Powders. The remissions occurred every
morning, the exaccerbations during the afternoon but loos-
ing their intensity before midnght. The 13th, 14th, and 1 5th
he was evidently improving, the evening exaccerbations not
being at all discoverable, his tongue cleaning off, and
his appetite in every respect better. He was not watched
during the night ofthe 15th. On the morning ofthe 16th, he
rose from his bed, and setting on its edge, alarmed his
servant by ineffectual efforts to speak. I was immediately
sent for, and on examination found the whole right side
paralyzed. On laying him down he manifested a desire to
be placed on his right side. It was done, and immediately
he became pale, pulseless and gasped for breath. He was
turned back to his left side, stimulents were applied and af-

Ramsey's Report. 31

ter a few moments he recovered. He was again placed on
his right sido, and immediately the same evidences of speedy
death presented, and were again prevented by turning him
on the other side. He died during the afternoon. What
connexion existed between the paralysis and the heart af-
fection and the utter inability to lay on the right side I can
not determine. A post mortem was asked for, but denied.
Menorrhagia. — In all the cases of Menorrhagia Matico
was the agent used, and with most perfect success — the dis-
charge being checked very soon after the administration of
the first dose of the decoction, made from half an ounce Mat-
ico to a pint of boiling water and given in half ounce doses,
repeated according to circumstances. I ordinarily use this
agent, but from the fact of having been disappointed once or
twice, I occasionally in very severe cases use other reme-
dies. In these cases nothing else was used.

Constipation. — The multifarious effects consequent on con-
stipation, and their sometimes frightful appearance, fre-
quently cause great difficulty as to a knowledge of the exact
condition of patients. Thus, one of the patients referred to
as costive, a young lady in full health, and perfect em bon
point, on returning from church fell and was picked up sense-
less. It might very readily have passed for an attack of ap-
oplexy; and from all the observable circumstances I would
have employed blood-letting, but on very minute enquiry I
was fully assured that she was habituall) constipated, and
therefore, directed a free injection, which operated promptly,
and she was very soon relieved.

Hozmoptysis. — A young cold female, generally regular,
no flow of menses past six weeks. Matico and warm foot
bath promptly suppressed the hemorrhage. Anticipate con-
sumptioif from family tendency.

Ramsey's Rejwrt.

MAY, 1851.

Diseases.

Sore J'hro.it,

Pneumonia,

Constipation,

Colic,
do

Diarrhaea,
do

Dysentary,

C. Infantum,

C. Morbus,

Hysteric-convuls

Accidents,

Perturition,

Chlorosis,

Epigastric Pain,

Constitutional ir-
ritation, Alveola
abscess,

Ulceration Cervix

Menorrhagia,

under 15

15to35

over 35

under

VI | F

M
1

4
2

2
2

I
1

4
1
1

1
1
1

1
2
1

2
1
1
1

3
1

DEATHS,

15 to 35 over 35

A I

M I F

Of this total, five resided in the country — two transient visitors to town.
Epigastric Pain, sent to me from an adjoining county. Dr. Sneed, Straw-
berry Plains, has the case still under observation.

In making out this table I have only enumerated, such
cases as presented during the month, not counting again the
same cases enumerated in the table for April, and which
[were yet under treatment during a portion or all of May.
And this will be my course, except when otherwise it will
be mentioned.

Diarrhea. — In the adult male was distinctly traced to eat-
ing fish. The discharges were accompanied with great
abdominal pain, and spasm of the muscular parieties. Re-
lieved after free purgation. In 2 cases, male children — aet. 2
and 4 years, same family, it was certainly traced to straw-
berries. During the straw-berry season of the year 1850,
I had the same children as patients, affected with diarrhea,
from the same cause. Calomel, Oil and French Brandy re-
lieved in some four days. In the other cases, the children

Ramsey's Report, 33

were all teething, and were relieved by lancing the gums
freely, and a few doses of Hydg. C. Cret. I can not see
why any practitioner can object to lancing gums in any af-
fection occuring with children during the process of teeth-
ing. The awful itching of distended gums when it does not
originate, can but render worse and irritate any existing
disease — 'and I see no way to destroy this sensation but by
lancing. I have been called out since I commenced this
sheet, to see a child nine months old, whose mother was in
tears, for fear of convulsions, and from sorrow for the awful
and mysterious pain which made her chill scream so loud
and so long. Its bowels unaffected — two or three dischar-
ges daily, surface not warm, abdomen soft, head a little too
warm, urinates freely, pulse 120 and light, his gums vety
red and swollen, and bigtes the nipple; I freely kneed the
gums, and in two minutes the cries were hilled, and the
poor babe with a smile recognized its parent's* efforts to give
amusement. There is no article of the Mar. Med. on which
I so much rely for benefit in treating the Bowel affections of
children, as Hydg. C. Cret. But I have it prepared fre-
quently and in small quantities, from pure washed Mercury

and the best of precipitated chalk. After a time, sooner or
later, it undergoes some change which wholly unfits it for
the impression ordinarily expected; this change is indicated
by the preparation becoming granular and dry. After I
observe this physical character, 1 lay the preparation aside
as unfit for use.

Parturition. — A midwife in attendance, discovered a
shoulder presenting. I turned. Child asphyxiated. Bled
the cord. Alternated warmth and cold, insufflated, and af-
ter half an hour a spasmodic respiratory act crowned my
efforts. After one hour of the hardest work I ever done, I
laid the child in the nurse's lap. It is now a fine fat. thriving
girl.

Epigastric Pain. — Obscure. I had the pleasure of con-
versing about this case with Prof. Carson, of Penn. Univ.,
who saw the patient, it is yet under observation.

Dysentery, — This was a very violent case, but yielded

Ramsey's Report.

to the prescription I ordinarially employ. Lye poultices,
and if necessary Blisters to the abdomen, and internally in
table spoonful doses repeated according to circumstances,
R. Sul. Soda, 2 drachms Sul. Morph, 2 grs. Aqua Camph. 4
ounces M. Ft. Sol. In some cases incidental circumstances
may induce the application of other agents, but my reliance
is on this preparation for which I am indebted to Coventry's
article, N. Y. Medical Journal, 1825.

Cholera Infantum. — If called during vomiting, or soon af-
ter I almost unitormly commence with a large dose of calo-
mel — I,have never seen causes to regret the practice, never
having lost a case in which it was put in play. One of the
cases noted in the tables continued for many weeks. I had
the pleasure of our old friend Dr. Drake, to see it with me.
This practice, from some circumstance, the mildness of the
first evidences of derangement of health — was not followed.
It will be hereafter noted. Cholera Morbus, an old lady
near 80, an enormous eater, with a Schirrus Tumor of the
breast. She will be placed in the table of another month.

JUNE, 1851.

Diseases.

under 15

15 to 35

over 35

w
m

5
3

Cholera Infantum,
do

Dysentary,
do

1
1

2
1

Fever, Renritent,

Fever, Typhoid,

Diarrhea,

Chlorosis,

Cholera Morbus,
do

w
m

Accident,

Costiveness,

Ephemera,

Fev%r, Intermit't,

Consumption,

Abortion— Hcemor.

Lichen-Fever,

Senile Cough and

Debility,

Hysteria,

Menorrhagia,

Nine of this tota

jsidec

[in t

he c

oun

try-

-ont

t trani

under 1 5

DEATHS
15 to 35

M F

ov.35

M F

Ramsey's Report. 85

Remittent Fever. — Male, the same affected last month
with Dysentery, from which he was wholly relieved before
attacked by Remittent Fever. I visited him three days;
Sul. Quin. completely subdued every symptom. He is now
very hearty, as it is reported in town, that he ate at one
breakfast a short time since 'twenty-five Biscuits.

Typhoid Fever. — At a time when I was confined to my
room, I was called on to prescribeTor a young lady, who
was represented as having been some weeks before the sub-
ject of Diarrhea, which had been easily cured, after which
she became too costive, and was in the rain during menstru-
ation which was checked. I prescribed a hot foot bath and
as occasion might require a mild laxative pill. Some days
afterward I was summoned to visit her; she had taken too
many pills, was tympanitic, frequent small watery floccu-
lent and yellow discharges, skin not hot, thirst considera-
ble, pulse 120, very thin and round^-what I recognise as
thready, tendinous twitchings. In short, it was a case of
Typhoid Fever aggrivated by too many pills — though they
were mild. By the treatment adopted she improved very
much, the discharges altering gradually in quality, the pulse
reducing in frequency, and the appetite developing favora-
bly. The Prs. was made during the first three days of the
month, and my first visit was paid on the 17th. She had
been sick for several days, and had taken some purgative
medicine. On the 27th, the 11th day of my attendance, she
eat without my knowledge two roasted apples, and a bit
of green apple pie- At my visit next morning she was in
every particular worse than at any time since her attack,
and continued getting worse until the next day, 29th, I call-
ed for counsel. The best directed efforts failed to retrieve
the injury done, as I conceive, by the roasted apples and pie.
She will be recorded in the table for Julv; she became com-
atose, and died July the 3d, six days after eating the apples
and pie; a larger portion of the time she passed in muttering
delerium.

35 Ramsey's Report.

Dysentery. — One of the cases was a consumptive pa-
tient. — The preparation before referred to gave speedy and
perfect relief.

Chlorosis. — Two sisters, one had Amenorrhea without
any other very open manifestation, except general debility.
The other had convulsions, was unable to be moved, uni-
versal soreness of the surface, no medicine that I could think
appropriate could be given — it would be almost instantly
rejected. 1 he most delicately prepared diet — cold water, oc-
casioned vomiting. She had been more or less so for two
years, getting progressively worse, suffering many things of
many doctors. After a legitimate effort without effect, I or-
dered the best French Brandy, telling her friends to keep
giving it even though she threw it up, but I had but little
idea of any other result than death. 1 he brandy was per-
severed in, and though she is not now a healthy woman, she

is out, without convulsions, and in better health than for
years.

Cholera Morbus. — In the larger number of cases was oc-
casioned by cherries, in other cases by eating something else
offensive to the digestive organs. My own attack not men-
tioned in the tables, was from cherries.

Accidents. — Swol lowing a bit of glass, will be referred to
in table for December. Fracture of both bones of the fore-
arm. A fall from a swing in motion — 15 feet with force,
pain over right kidney, pufflness over the region of pain, in- *
ability to get up, urine slightly bloody, recovered after a
few weeks. Was the kidney ruptured?

• Lichen — Occured in a house adjoining one in which it
was said Scarlet Fever existed, and was pronounced by un-
professional observers in every respect assimilated. The
fever was very high. Patient well within forty-eight hours.

Diarrhea. — By far the larger number of the cases, Diar»
rhea of teething.

Ramsey's Report.

JULY, 1851.

DEATHS.

Diseases.

undor15 15to35nver35

under 15

15 to 35 over 35

IV 1

^i P VI

| iVi

Typtioid J? ever,

Remit. Fever,

Diarrhea,

}I0

C. Morbus,

C. Infantum,

Cost i veu ess,

I 3

Hrlema Gestation.

Hysteria.

Consumption,

Anemic Edma.

Hemephlegia — left

Accidents,

Syphilis,

Jaundice,

Menorrhagia,

Dysmenorrhea,

Labor,

Scrofula,

]

Typhoid Fever. — Female — fatal. Consultation called so soon as the
presence of aggravated symptoms wadpdiscovered. History given under table
of last month.

Consumption— Consumptive for many years. Has been traveling for three
months with diarrhea and tenesmus — was under my care from 5th to 17th.

Accident. — Consultation from the first. Four present at first dressing,
had care of the patient from the second dressing. Trismus on the 14th, ac-
cident on the 4th.

Labor. — First Labor, impacted head, bled the cord, child does well.

Three of this total resided in the country.

Typhoid Fever. — White-male — fatal. This patient was
related to myself, was an only son, and from unfortunate
circumstances, members of the family were peculiarly timid.
I was called on the 2nd, and found him complaining of some
soreness, and discovered slight swelling of one knee-joint,
headache, tongue white-fur and moist, pulse very fine and
rapid, and bowels resonant on percussion. He had been
ailing for a day or two, and had taken a small dose of Cas-
tor Oil; his discharges were thin, yellow and flocculent. I

38 Ramsey's Report.

gave my views of the case and treatment, and administered
a dose of Castor Oil, Turpentine and Laudanam. In its
present aspect, did not consider the case very bad. 3d, Pa-
tient more comfortable though the quick pulse, resonant bel-
ly, and thin discharges yet prevail. 4th, Patient not visited
on account of the accident of the table preventing — under-
stood to be more comfortable. 5th, More restless. 6th,
Another physician was called who confirmed the views of
the disease and attack, and approved the principles of treat-
ment employed. 7th, Before day another practitioner was
called, which occasioned the voluntary withdrawal of the
second, from the nature of his personal relations with the
third. At this time of the symptoms mentioned, great rest-
lessness was the most prominent, and complaint when the
joints of the lower exiremeties were disturbed, the knee some-
what more swollen. He received a history of the case,
made his examination, and declined an opinion until morn-
ing. At our next meeting he decided the attack to be In-
flammatory Rheumatism. A difference in our opinion oc-
casioned a fourth practitioner to be called. After examin-
ing and receiving a history of the case, he said it was what
he had been accustomed to regard as Inflammatory Fever,
with Typhoid tendency. Being thus over-ruled, I declined
occupying the position of first physician, but from family
considerations remained connected with the case, it being
well understood that I did not coincide in the general views,
and of course could not in the details of treatment. It is
proper to say in justice to the practitioner last called that
he expressed the opinion that blood-letting at an early pe-
riod of the attack would probably have prevented the exist-
ence of the present condition of the patient. A purgative
treatment was adopted, employing at different times Calo-
mel, Jalup, Castor Oil and Turpentine, and Senna, with in-
jections. From this date the patient grew progressively
worse, the pains of the joints more severe, the bowels became
more and more distended, until they refused to act, pulse

Ramseijs Report 39

more and more thready and quick, tongue dryer, delirium,
retention oi urine, dark purplish spots of greater or less di-
ametre at different points of the surface, an abrasion of the
hip as large as the hand, until the 13th, when he died coma-
tose. He was not sick more than 15 da\s, 12 of which he
was under the care of practitioners. He was not confined
to any one position, being frequentty turned, though it is true
he lay for the most part on his back.

Remittent Fever. — Occured in a young man belonging to
a Steam-boat plying between this and points below, on the
Tennessee River. Quinine very promptly subdued the at-
tack.

Diarrhea. — The cases for the most part could not be trac-
ed to any particular error of diet, There seemed to be "a
constitutional tendency" to bowel affections, several cases
being prescribed for, not visited, which are not placed in the

table.

Hysteria. — This case was interesting, a woman subject to

hysteria now gestating, and within two months of labor, and
has been in convulsions alternating, from time to time, with
parturient throes, for several weeks. Though the pains
seemed to be in every particular,natural and strong,they nev-
er produced any eflect on the mouth of the womb until the
final completion of her term. She was safely delivered by
another practitioner whose patient she was, and whose tem-
porary absence was the occasion of my being called.

Consumption. — I have under my care several cases not
mentioned in the tables, because they occured to me before
the month with which I have commenced. New cases only
are noted here.

Jaundice has prevailed to an extent that may entitle it to
be designated Epidemic. The only thing which I have seen
worthy of note is the universal prevalence of white stools*
and the very abundant urine loaded with a deep coloring
matter which I have never tested. The cases which I have
seen have been mild, requiring an occasional blue-pill. The

40 Ramsetfs Report.

pulse in every case was low, and I resorted to the use of
French Brandy; blue pill failing to destroy the white char-
acter of stool, a yellow tinge running rapidly into a diffused
yellow or brown soon followed the use of the Brandy. I
gave it in tea spoonful doses, repeated according to circum-
stances.

Parlysis. — This case has caused me to refer to two others,
one of face — neither possessed any discoverable appoplec-
tic element. One a negro woman who drank Coffee almost
incessantly — keeping it by the fire during the day and using
it as an ordinary drink. She was "struck" at the wash-tub,
without any premonition whatever — no pain, no particular
condition of pulse — costive. Calomel as a purgative, fol-
lowed by very active purgative combinations,and externally
friction and stimulating liniments. She was relieved in a
few hours, and resumed her ordinary occupation in usual
health after a week or two. I have understood that she
occasionally has slight paraletic manifestations — she has
left here.

The case of the table. Many years ago was accustomed
to drink freely but has been since a cold water man, has a
large family, but limited means. Recently put at the head
of a business with an interest in the profits, he has been
much concerned trying to prosecute it with eminent suc-
cess. Sleepless for many nights, costive, uses tobacco, and
drinks coffee excessively. Tried to get out of bed, succeed-
ed but attempting to make a step fell; tried to speak, but
couldn't. The same course indicated above relieved very
promptly, but after a week, recovery not being complete, he
was bled with marked good effect. His allowance of cof-
fee limited and regular purgatives since, have prevented an-
other attack, though a time or two since his "tongue has be-
come thick"

Has Coffee any influence in the production of Paralysis ?

Accident. — A compound comminuted fracture of the arm
and wrist, from the premature discharge of a four pounder

Ramsey's Report. 41

whilst he was ramming. Amputation was not performed
until the accession of Trismus, but it was then followed by
no good result. The excessive heat of the weather, without
doubt, was the essential cause of the lock-jaw and con-
vulsions of this case. The Ext. Hemp was tried but abso-
lutely made no impression. Cloroform at length was resor-
ted to, and mitigated the violence of the spasm. He died
36 hours after its onset, and about 30 after amputation.
Tiie flaps had adhered.

AUGUST, 1851.

Diseases.

Ephemera,

do
Typhoid Fever,

do
Remit. Fever,
Diarrhea,

do
C. Morbus,
Catarrh,
Costiveness,
Crimp Colic,
Jaundice,
EpileptiformConv
Menorrhagia,
Flooding Second'y b
C. Infantum,

1
1
1
1
1
1
1
1
3

24
Of this total, five resided in the country; one traveling,
Remit. Fever. — Returned from California, and taken sick within a week.
Epileptiform Convulsions. — Habitual.

Secondary Hemorrhage. — Delivered 29th July — Flooded 28th August.
Cholera Infantum. — Attacked 24th May — died 29th August. Most com-
plete marasmus.

und

3rl5

15to35

ovei-3 5

M
1

■w
b

1
1

w
b

1
1

un.15

M r F

DEATHS.

5to35 ov.35

M F M F

Typhoid Fever. — The only observation which 1 have to
make on the table of this month is the fact of the two females
with Typhoid Fever, being members of the same family
with a male numbered in the table of last month. The male
was visited on the 21st July, had been sick several days.
The youngest female was prescribed for on 20th August,

42 Ramsey's Report.

and the eldest on the 28th August. They run through the
month of September, but will not be enumerated in ihat table;
they all recovered. This is the second time within five
years that I have had more than one case of Typhoid Fever
in the same house. But I have so frequently attended one
member, and all orhersof a family remained unaffected, that
I am not disposed to entertain views of contagion.

Uterine Hemorrh ge Secondary — The case of Secondary
Utarine Hemorrhage occurred in the woman delivered last
month. Her labor was her first, commenced about eight
o'clock, a. m., and terminated near twelve at night.
The head was f«»r a long time stationary aft ?p it had
engaged in the bones, the womb fully dilated, the mem-
branes broken, and waters discharged. The labor was not
interfered with, as nothing occurred to cause me any par-
ticular uneasiness. The scalp of the child was very much
swollen, but soon subsided. There was no delay of the pla-
centa map — the hand laying on the abdomen and sustaining
the contraction of the womb, being all the aid necessary to
the comolete expulsion of its contents. There was not more
sanguineous discharge than is ordinary — none before the
birth of the child. She did well, and her child is a fine chub-
by negro.

Ramsey's Report.

SEPTEMBER, 1851.

Diseases.

Fever. Remittent,

Fever, Intermit.,

Jaun (ice,
do

Diarrhea,
do

Chronic, do

Cholera Infantum
do

Cholera Morbus,
do

Colic,

Paralysis— -Albu-
minous urine,

Excessive desire
to urinate.

General Dropsy,

Sore Throat,

Croupy Catarrh,

Whooping Cough.

Consumption,

Indurated Breast,

A ccidents,

Convulsions,
do

Erysipelas,

Globus Hyst.,

P .rturition.

P.irt. Premature,
Menorrhagia,

unier 15 15 to 35

15 9 7 10

over

un.15

VI F

DEATHS.

<)V

15 to 35

;VT

I 1

Of this total ten resiled in the country — cue temporarily in town,

Indurated Breast. — The case of Indurated Breast is so
recorded m my visiting list. She had been under treatment
for this afFeciion — Iodine Ointment — more for the purpose of
satisfying her than with any hope of reducing the indura-
tion. She was sixty years old, very corpulent and flabby,
had had one or two attacks of Appoplexy — so reported.
Some time during the night, she had an attack resembling
Asthma, to which so far as I have been able to learn, she
was not habitually subjected. For two days every plan of

44 Ramsey's Report.

medication adopted failed, and she passed into comma, on
the third day, and died on the fourth.

Did the Iodine Ointment exert any influence ? Was the
attack in any way connected with the state of the breast ?

Albuminous Urine. — I was called to this case to allay an
excessive desire to pass water — used Co., Ext. Buchu suc-
cessfully, the paralysis and albuminous urine yet continue.
The second case of this kind relieved in the same way.

Dropsy. — Called during the absence of regular attendant.
Had been under treatment a year: comatose when I saw it.
Died the next morning but one.

Consumption. — Called during absence of regular atten-
dant — had been under treatment a year — continued jointly,
?ifter his return — case enumerated in table of next month.

Ramsey- s Report.

OCTOBER, 1851.

DEATHS.

,underl 5,15to3{
,vi 1 F M b

5 over

underl515to35

over 35

Diseases.

VI!

iVl

Fever, Typhoid,

w l\\ ~~

Fever, Remittent,

- 2\ 1

;

Ephemera,

Catarrh,

Sore Throat, (Ha-

bitual.)

Whoopino;-Cough,

i
i

Consumption,

Pleurodyne,

1 -

Accidents,

C. Morbus,

Diarrhea,

Jaundce,

3 3

Globus Hyster.,

Lead Colie,

1.1

Sore mouth, (nurs-

i I 1

ing,)

1 H

Abortion,

Menorrhagia,
do

Parturition,

Cancer Uteri,

; i

j i

Drunk. Delerium,

ii'

Cerebro-spin. men

: i

Hematurea,

i —

_ —

— ii

1 30

1 4

7 1

3 4

1 41

Catarrh. — A profuse discharge from the nose and eyes, •with more or less
cough — generally loose, accompanied with Fever. It generally received the
name of Influenza, and probably correctly; but the term is so very indefinite
that I prefer not to use it. It prevailed somewhat extensively, and later in
the history of its prevalence, had a new feature added. It will be referred
to in a subsequent table. It was from first to last, easily treated.

Consumption. — The case referred to as coming under my care secondarily,
died. He had been to Florida, but I am unable to say, from the account re-
ceived from friends, as to the effect — I feel tolerably sure that the effect of
travel was beneficial, for the time. The other cases are under the Cod Liv-
er Oil Treatment. I am certainly prejudiced much in favor of this article.
I have seen it do good service.

Pleurodyne. — A very nervous female, surface so tender as
to forbid me even touching it. Reports that she was treat-
ed in New York for diseased lungs, by pustulation, blisters,
and emetics. A poultice of hops and wormwood gave re-
lief, and pills for many days after the attack, composed of

46 Ramsey's Report.

Val. Assafaet. Orange-Peel. and Soap, made her "feel quite a

new woman."

Jaundice. — One of the males left on business for New
York, at a time when Jaundice was in his family. He was
gone six weeks, and became Jaundice at Richmond, Va., on
his return home. I may observe t h it all the cases of Jaun*
dic^ which fell to my charge resided in the same quarter of
the town — six in daily communication, an 1 ihe other living
on the same square, or on the opposite side of the street.

Is this worth anything to con'agionists ?

Globus Hyster. — A young ■» an who had )een underexces-
sive excitement at a Camp Meeting — they pronounced him
"under conviction."

Sore Mouth — Completely cured by the free use of Liq.
Oxy-Sul. Iron, one of the best preparations of Iron which
pharmacy furnishes.

Abortton. — First conception — tenth week — woman in per-
fect health, most unequivocally produced by high mental ex-
citement.

Menorrhagia. — Believed to have been a procured abor-
tion.

Cancer Uteri. — I was called in consultation on this case
the 1st of April. It. had then existed for two years — fre-
quent hemorrhage, fetid discharges had worn th patient to
a complete frame- work. And until another practitioner and
myself were called upon in consultation, no vaginal exam-
ination by touch or speculum, had been instituted. The
treatment had been general, except inefficient vagina! injec-
tions ol Chid. Soda. These examinations developed a fissur-
ed orlobulated velvety condition of the whole neck of the
womb, bleeding on the slightest touch. They were touched
with Nit. Silver— Acid Nit. Merc. After such application
she seemed to regain strength — and certainly did — for she
was able to get up out of bed for a little while— which before
she could not. The applications always allayed the pain,
which was excessive at the left of the pubes. She died com-
atose, having had Diarrhea and Aptha for ten days before
death.

Ramsey's Report

«?

NOVEMBER, 1851.

Di senses.

Fevei, ftcUiiuem,
do

Fever. Intermit.,

Parturition,

Prurit. Vulv.,

Pneumonia,

Catarrh-excessive
pain F Sinus,

Incidents of Ges-
tation,

Constipation,

Irritat. Teething,

Diarrhea,

Jaundice,

Scrofulous Indura-
tiou or chin,

Indurated BreastJw

Hyster. Convuls. 'm

Convuls. Teething w

Conj Eccbyinosis. w

Convulsious,

Accidents,
do

Suppuration of leg
from injury to
Ancle,

Three of this tota

under 15

iVI

15 to3.">

.vj

nvor 35i

vl >

resided in the country.

}«

DEATHS.

i male— 15 to 3 5.

Fever, Intermittent.— ,J>u\mon(iry complication.

Ctnvwlsious.— Was sick a week under the charge of another practitioner.
Took convulsion at 8 A. M.— at 12 M. I saw him, not knowing that he had
been sick, or that Another practitioner was in attendance. He died daring
*&• evening.

Ramseijs Report.

—

., 1

DECEMBER

851.

deaths;.

under 15 15 to 35ovei

un.15

15 to 35 ov.35

Diseases.

i .,

M F

M F i M F 1 M

M F

Pever, Typhoid,

"'l|

[

Fever. Remit,

Fever, Intermit.,

Jaundice,

R I'd Membranes,

Sore Throat,

fej

Catarrh,

Hemor r h o i d s —

Gestation,

Abscess,

Inflamed Bowels,

Dysentery,

Marasmus-cough,

' VV

Convulsions,

Pneumonia,

Croupy Catarrh,

Hyp<>condria,

Ovarian Tumor,

Factial Paralysis,

Const ip;itio .<,

Pemphigus,

1
11

Hemorrhage from

Abortion,

Parturition,

Burn,

) u

Irritat., Teething

.."

Scirrhus of Breast

Tumor,

Diarrhea Infantile

J 1

Of this total, 7 reside in the country, 1 in an adjoining county.

Fever, Intermitent. — On just returned from Arkansas, where he had, for
some time, Remitent Fever. The other lives in a low situation, on the bank
of a very swift creek— jast on its edge. The attack assumed the character
of Int. Ceplealgia, and was relieved by Salicine.

Jjiflamed Bowels. — I was called in consultation 24 hours previous to her
death.

Marasmus, cough. — Is fast recovering under Cod Liver and Neat's Foot
Oils.

Convulsions. — Both under three years of age, caused by repletion of
siomaoh.

Pneumonia. — Mercurials and Opium, with Poultices in the younger, and
Blisters to older patients, the ordinary treatment.

ISeirrhus Breast. — Assisted Dr. S.Howard Dickson, Excis

Ramsey's Report 49

Tumor. — The case of Tumor was situated in the flexure
of the thigh, thepat'ent laboring under great mental agony
and physical irritation. I was called, in connection with
three other practitioners, beside the regular attendant. The
patient was fully advised that an operation offered only a re-
mote chance of life — he desired to have that. He died 12
hours after the operation, having favorably made evidence of
reaction. The case will be fully reported for publication.

Burn. — The case of Burn, a negro wench, involving the
whole surface before and behind, of the body, except the
right side. She reacted from the shock — the surface suppu-
rated, and she lived for two weeks after the accident. Was
to all intents doing better than had been anticipated ; but
two days before death, she threw her bed-cloths off, tore off
her dressing, (cotton,) and lay thus exposed for more than
five hours. She commenced getting Typhoid, and died com-
atose. No unpleasant evidence had been observed until af-
ter the exposure of the suppurating surface.

Diarrhea. — The case of Infantile Diarrhea — one of the
children, recorded as being born last month. It was the re-
sult of cold, the child having been permitted to get so cold
as to require friction, hot blankets, &c, to get it to react. It
was immediately on the return of heat to the surface, taken
with frequent small discharges and great pain.

Free inhabitants of the town of Knoxville.

Under 15 I 15to35
M | F M I F
321 355 375 279

over 35
M I F

147 148

Total population, 2350 — the
remnant blacks.

FEB 17.1928

50 ^^ZSftioAc//- on Alcohol.

Art. VII. — "Is Alcohol removed from the System through the
LungsT' Communicated by J. B. Mitchell, A. M., Princi-
pal of the Hampden Sydney Academy.

The opinion is extensively entertained that Alcohol, in the
various forms in which it is used, is entirely incapable of
undergoing any transformation when taken into the stom-
ach, and that it is chiefly, if not wholly, removed from the
3ystem through the lungs. The fact that an ounce of bran-
dy will communicate its odor to the breath for half a day-
is offered as conclusive evidence. But a single grain of
some perfumes will impart their odor for a much longer pe-
riod; and the quantity of Alcohol retained by the glands of
the mouth and throat is sufficient to vitiate the breath for
many hours, to say nothing of the amount which may arise
in a volatile form from the stomach when it contains a con-
siderable quantity.

Without some other facts, it would be needless to specu~
late upon the manner in which Alcohol is removed from, or
the changes which it may undergo in the system. If Alco-
hol be thrown off unchanged by the organs of respiration,
may it not be collected and exhibited again in its usual
form? The following experiments were conducted for that
purpose.

Two of the three necked bottles of Woulfe's apparatus,
were half filled with water. A glass tube about 30 inches
in length was inserted through a cock in the neck of one
bottle to the bottom of the water; so that the breath blown
through this tube w r ould pass into the water of the first bot-
tle, and then through the bent pipe connecting the appara-
tus, and again through water contained in the second bottle*
By this means all the air or gas thrown off by the lungs
during respiration, would be thoroughly washed, and such
is the well known affinity of Alcohol for water, that it would
be condensed and retained by the water in the bottles.
A man accustomed to the use* of ardent spirits, and who

Mitchell on Alcohol. 51

had, daring the six hours previous, d f loast a pint of

common whiskey, now drank half pint more. He was then
caused to apply his mouth to the :; i u be, and by inhaling
atmosphere through his nostrils, lie continued (with occa-
sional intervals of rest) to respire through the water in the
apparatus for about three hours. The contents of the bot-
tles, which then smelled distinctly of alcohol, were careful-
ly distilled in a large glass retart until the residue no longer
retained any alcoholic odor. The product of this distilla-
tion was (with the addition of lime) redistilled at a low tem-
perature, and then again further concentrated until less than
a teaspoonful w r as obtained. The odor and taste of Alcohol
were distinct — it was ignited by a taper and partially con-
sumed.

Another individual after drinking about as the one men-
tioned cleansed his mouth and throat thoroughly with water
— ate some bread and drank a glass of milk. He then
breathed into the tube as the former one, and for the same
length of time. The water contained in the apparatus af-
forded a feeble alcoholic smell. It was distilled and con-
centrated as in the first experiment. The smell of alcohol
was evident, taste scarcely perceptible, could not be ignited
with a taper.

If Alcohol was* thrown off entirely by respiration, it is ev-
ident that in the space of about three hours, a much larger
quantity would have been obtained; if it was chiefly given
off in that manner a much greater amount must have been
detected.

A small proportion probably escapes through the lungs,
because at a low temperature it is capable of being con-
verted into a vapor, which easily penetrates and passes
through the membranes. Owing to this fact, traces of Al-
cohol have been detected in various parts of the body, par
ticularly in the brain, from which the cranium no doubt pre-
vents its escape. But much the largest portion, after hav-
ing entered into circulation with the blood, undergoes chem-

52 Mitchell on Alcohol.

ical change — decomposition. The composition of Alcohol
isC 4 H 6 O'; and such is the affinity of its elements for ox-
ygen, that when diluted with four or five parts of water, it
will spontaneously abstract that substance from the atmos-
phere. Therefore, it is easy to understand how the oxygen
supplied through the lungs to the arterial blood, would unite
with the carbon and hydrogen of Alcohol, and form carbon-
ic acid and water. That matter which is thrown into the cir-
culation, and which changes the color of arterial to venous
blood, must be deprived of its usual supply of oxygen —
respiration tails to purify the blood, and increased activity
is required of the kidneys, liver and organs of perspiration.
This undue excitement enables us to account more satisfac-
torily for certain derangements to which the intemperate
are subject, than the "opinion" mentioned at the commence-
ment of this article.

It is a well known fact in chemical physiology, that
the continual decomposition or metamorphosis of animal
tissues, is owing to the action of oxygen which is distribut-
ed throughout the system by the arterial blood. But the
greater facility with which oxygen combines with the ele-
ments of Alcohol, to some extent, checks this transforma-
tion. The process of digestion must therefore be diminish-
ed so as to furnish a smaller amount of matter for assimila-
tion, supply of waste, &c., or that swollen and bloated ap-
pearance will result, which is so frequently observed in those
much accustomed to an intemperate use of spirituous liquors.

&NOXVULE, March 10, 1852.

ECLECTIC AND SUMMARY.

From a paper entitled, "Prevalence of Quackery in Amer-
ica," by Dr. J. H. Stuart, of Penn., and published in the N.
J. Medical Reporter, we take the following, most earnestly
recommending it to the careful perusal of very many wor-
thy practitioners of East. Tennessee, who are withholding
themselves from the pleasures derived from association and
the advantages of organization.

"Our country is essentially a money making one. Time
is occupied in accumulating wealth, but very little in spend-
ing it. Let a man only succeed in his attempt to 'gather
gear by every wile,' no matter whether 'justified by honor'
or not, and he is almost universally respected. Nothing is
despised by which the great object is attained. Men are
very anxious to punish a robber, for he takes forcibly from
them their hard earned gains. But the quack steals so in-
directly that they are scarce conscious of the theft. They
consider his trade a business one, and regard their inter-
course with him as a struggle of cunning. No one desires
to suppress his vile trade by law, for each individual sup-
poses himself sharp enough to escape from his clutches, and,
as each is successively outwitted, he maintains a discreet
silence, lest he should be known tor a fool. All the quack's
successes are bruited abroad, because the one who speaks of
them feeds his own vanity by showing the extraordinary in-
telligence which actuated him in employing the charlatan.
His failures either occupy nameless graves, and "dead men
tell no tales," or halt through life in sullen silence, for it
would do no good to warn others, and human nature leads
them to smile grimly, as one after another drops into the
same trap which caught them. The leniency of the law is

54 Eclectic and Summary,

a great cause of quackery; but I can not consider that a de-
cided evil, so long as innumerable medical schools send out
# hundredsof ignorant doctors annually, a diploma can not
be considered a proper criterion of ability. Hence, any
law discriminating merely between graduates and non-grad-
uates, would be unjust. A radical change must be made,
or none at all. It is unfair to say to one man, You have
not had means for a collegiate education, therefore, you shall
not practice; and to another, You were able to buy a diplo-
ma, therefore, you shall. Perhaps the main cause of quack-
ery is the want of union among educated medical men. In-
stead of joining together to suppress all irregular practice,
they are much more apt to be engaged in decrying each oth-
er, either directly or by knowing looks and innuendoes.

"People soon remark this, and naturally think, if these
men have not confidence in each other, how can we confide
in them? They are distracted how to decide among so many
conflicting interests, and too often betake themselves to
quackery for relief, as the soul tossed about in the sea of po-
lemic theology, too often seeks rest in the dark abysses of in-
fidelity. There is also a want of moral honesty too preva-
lent in the profession. Physicians will resort, almost uncon-
sciously, themselves, to peXty tricks, which a moment's reflec-
tion would assure them are highly reprehensible. For in-
stance, they will assume infallibility, and pronounce positive
opinions on subjects of which it is really impossible to be
certain. These opinions, of course, often prove fallacious,
and the community, deceived and disgusted, turn to the
mountebank, who promises the most ridiculous things, with
a feeling that they are not much more likely to be cheated
by him than by educated men. Medical organisation has
done much, and let us hope, will yet do more for the sup-
pression of quackery; but is not as efficacious as it might,
and ought to be. For the prevalent opinion regarding it is,
that it is undertaken, not for the good of the community, but
for the private advantage of the individuals associated to-

Eclectic and Summary. ' 55

gether, and to put down certain others whose interests are
inimical to theirs. And no pains is taken by us to change
this opinion. JVo means are used to convince the laity, that
scientific physicians unite, not to put down, but to build up.
not for the further degradation ot those who are too low al-
ready, but merely to separate from, and declare their non-
identity with them. We think these few causes are the po-
tent ones of quackery. Now, what can be done to effect a
cure? Were it possible, it would be a good experiment for
all respectable physicians to cease practice entirely, for a
year or two. The massacres committed by quacks would
then be fully evident to every body, and many of them would
undoubtedly expiate their crimes by lynch law, victims to
the rage of those whose friends they had murdered. But
on the return of educated men to practice, a new race would
of course arise, perhaps worse than the former. If the
whole community could be well educated, it would suppress
quackery. But that is impossible. I see no other way,
then, but quietly and firmly to continue the great work of
reformation in the slow but sure course it is now taking; to
improve ourselves, to increase the stringency of our organi-
sation, and then, having thus done our duty, to leave the re-
sponsibility of their own actions with the people them-
selves. Thovse who have sense enough "to discern the evil
from the good," will profit by their discrimination, and it will
not be our fault,if those who have not,die in their ignorance,
perhaps after having been beggared by their gullibility, to
have inscribed for their epitaph,

" • He died a codger powny's death,

At some dike side."

56 Eclectic and Summary.

A case in which the Foetus is supposed to have perished at
an early period of TJtero- gestation, and the placenta contin-
uing to be developed, U)os expelled about the seventh month.
By P. S. Jones, M. D., of Carroll county, Tennessee.

Mrs. L., aged 28 years, the molher of three children, was
forced to bed on — day of — 1850, with uterine pains and
slight sanguinolent discharges. She had previously aborted
twice, during the six months of each pregnancy. In each
of which instances the writer was present, and witnessed
the expulsion of a dead foetus, placenta and membranes.
She considered herself enciente about seven months — hav-
ing had no menstrual flux during that period, together with
her usual symptoms of pregnancy, the motions of the child
excepted. She was undetermined on this point, sometimes
supposing that she felt its movements, at others doubting
that she had. I observed that the abdomen was not so
prominent as it was in either of the other instances of abor-
tion. No efforts were made to arrest the action of the ute-
rus, from the conviction that such efforts might only post-
pone an inevitable event. On the 3d day (the hemorrhage
in the meantime being very slight) ergot was given and a
placenta extruded. It was removed, placed in a bowl of
water, and the uterus narrowly examined for a foetus. It
was found well contracted, and on introducing the finger,
the cavity was found empty. The presumed placental mass
was thoroughly washed, and closely inspected. It was five
inches in diameter, its uterine surface presenting the lobu-
Jated appearance of a placenta, the other or foetal suriace
was covered with the membranes, and presented the
peculiar striated appearance common to placenta. The
lines converged to the centre, the point for the insertion of
the cord, from which floated several loose pieces of cord, or
rather what seemed to be the investing membrane of the
cord, about two inches in length. Several incisions were
made into its substance, and its texture found to present the

Eclectic and Summary. 57

peculiar appearance of placenta in the arrangement of its
vessels and cellular tissue, with the exception that the sur-
face or portion in relation to the cavity of the uterus, was
shrunken, or its substance not so fully developed, as the ute-
rine portion. It was rather more than an inch thick at its
centre. No child could have passed, after my first visit, un-
observed. The clots were preserved by the nurse, as di-
rected, and none escaped larger than the end of the thumb.
The lochial discharge was slight, with only its peculiar
foster.

The lady insisted that she had discharged nothing from
the vagina prior to my first visit — was an intelligent wo-
man, anxious to gratify her husband in rearing a large fam-
ily of children, and continually in fear of abortion, for which
reasons she could have as quickly detected any departure
from the normal course of pregnancy as any other woman.
She, after appropriate treatment, again became pregnant,
and bore a healthy living child. — Nashville Jour- of Med,
and Surg.

We are much pleased with the following remarks by Dr»
Parrish, Editor of N. J. Medical Reporter, and therefore de-
tach them from the connection in which they occur, for the
pleasure of the readers of the Record.

" 'Commodities are movables, valuable by money, the
common measure.'

"We advise, soothe, comfort, encourage, and sometimes
cure; these are mental and moral qualities; they do not per-
tain to the business of life, say such. Business men bar-
gain and sell; and, it may be, take a legitimate business ad-
vantage, and it would be dishonest not to exchange the
goods for an acknowledged equivalent But how is it with

58 • Eclectic and Summary.

physicians? They must be their own clerks, and bookkeep-
ers, their own collectors; sometimes their own constables,
justices and lawyers; and, at last, having made their records,
and kept their books by the midnight lamp, issued their
claims, and striven to collect them, are driven back to re-
pose as quietly as they can upon the thought that the pro-
fession of medicine is so nearly allied 10 a benevolent call-
ing, that the idea of moneyed compensation for medical ser-
vices does not seem to be appreciated by many, who refuse
pay when it is demanded. But we would not rob the pro-
fession of its philanthropic character. Its dignity is found
in its acts of kindness and love. And while we have al-
ways believed that legal restraints were not to be relied up-
on as the means of securing compensation, still we repudi-
ate the idea that the benevolent feature of the profession
should be taken advantage of, as an excuse for non-pay-
ment. When people learn to regard the opinions and servi-
ces of physicians as the value received, they will be willing
to pay for them; but now, many consider that the demand
made upon them, is for visits, and the time and trouble ex-
pended in accomplishing them ; and hence their worth is
graduated by the worth of time to others, and the trouble is
throught to be light in comparison with that experienced in
the exercise of physical labor. It behooves the profession
to maintain their true position, and, maintaining it, they
will eventually overcome the prejudice and ignorance by
which their energies are now enfeebled,

Eclectic and Summary. 59

Dr. C. C. Cleaveland, of Waterbury, Vt., communicating
to The New Jersey Medical Reporter, his method of treat-
ing Diarrhea and Dysentery, says:

"When called to a case of diarrhea, I am led to suspect
there may be some crude matters or vitiated secretions in
the stomach and bowels; and to remove them I Usually re-
sort to a cathartic of Turkey Rhubarb at once, and, if con-
venient, aid its operation by a copious simple injection; and,
if the case be one of dysentery I do the same, or omit the
rhubarb if the case be urgent, and cleanse the rectum and
colon by the injection only. After cleansing out the intes-
tines, I, ot late, have resorted to the use of sulphate of mor-
phia, sulphate of quinine, and tannic acid, either in pow-
der, or in solution, combined in such proportions as the case
demanded; and the same applied to the bowels, by means
of an injection of starch, to which this had been added. '•
In using the injection, I have directed the patient to lie up-
on the left side, that the position might tend to aid it in its
being retained; and I have also been very particular in in-
sisting that the pelvis be elevated as high as it can be with-
out distress.

Even from the first I direct a camphor mixture as follows.
R. Aq. Camph. Oij ; Acid Nitric gtts. xvi ; Opii. Tinct. | oz.
M. S. One table spoonful for an adult as often as the bow-
els move, or once in six hours until the patient is convales-
cent. This camphor mixture, I take from Dr. Mackintosh's
Practice of Medicine, who says, that with it alone, he can
cure more diarrheas and dysenteries than he can with the
entire armamentum medicines besides.

I am not certain but the chloroform of Dr. Parrish's cam-
phor mixture would be a valuable addition to this, and shall
make a trial of it the first opportunity. I have usually
found it necessary to order another cathartic, after three or
four days, to remove the secretions of the stomach and bow-
els that were too high up to be reached by injections, and
always direct spongings, sinapisms, and such other external

60 Eclectic and Summary*

applications as may be needed, but have never yet seen a
case of uncomplicated dysentery or diarrhea that to me
seemed to demand depletion by the lancet or by leeches.

Perfect quiet of the intestines, if that could be obtained,
together with a tonic, rather than a depressing course of
medication, according to my experience, is far the best for
derangements of the alimentary canal.

A Case of Spontaneous Evolution. By David Prince, M.
D. — Read before the St. Louis Medical Society.

On the night of the 5th inst., I was called to visit Mrs.
Barco, in the American Bottom, in labor with her 3rd child.

Drs. Dunn and Irish had been with the patient during the
night, and informed me, upon my arrival at 3 o'clock, A. M.,
that she had been in labor 12 hours, and that the right arm
had presented, with the palm of the hand forward, about 4
hours after the commencement of labor; the liquor amnii
having, of course, been previously evacuated. An attempt
had been made to turn, and bring down the feet, but the vio-
lence of the uterine contractions rendered this impracticable.
Bleeding from both arms, tartar emetic and tobacco injec-
tions, were of no avail in moderating the contraction to such
a degree as to permit the hand to pass between the child and
the uterine wall. Finding their efforts unavailing, the phy-
sicians in attendance discontinued their efforts, and awaited
the result of nature's efforts.

Upon my arrival, the right arm and shoulder were extend-
ed from the vagina over the right labium, but the chest and
abdomen doubled upon themselves and were much more
prominent. The pains came in paroxysms, but with much
lesV force than in the -early part of the night, and the patient

Eclectic and Summary. 61

exhibited a great exemption from exhaustion and had a
good pulse.

The left shoulder was easily reached by the finger, and
the corresponding arm readily brought down. A little trac-
tion upon the abdomen and skin brought down the pelvis
and inferior extremities, leaving only the neck in the vagina
and the head in the uterus, with the chin to the symphysis
pubis. With the forefinger of the left hand upon the chin,
and gentle traction with the right upon the neck of tha child,
(the patient lying upon her back) the head was expelled in
two or three pains. The child, a male of full medium size,
was still-born from the long compression of the cord. The
placenta soon followed, and the uterus contracted firmly as
in ordinary cases.

It is probable that the bleeding, tartar emetic and tobacco
had been of use in moderating excessive arterial activity
and diminishing a febrile or inflammatory tendency, but the
medicinal interference could only have shortened a process
which Nature would soon have terminated without this aid.

The child could not, in this case, be said to have been born
double, but the trunk certainly was. There was here a
turning, the reverse of that which art effects, for in the lat-
ter case, the breech is made to descend before the abdo-
men and chest, which make a curve with the convexity up-
ward and within the uterus, while in Nature's process, the
chest and abdomen descend before the breech, making a
curve partly in the vagina and partly without, with the con-
vexity downward. After the birth of the trunk, the breech
descends before the expulsion of the head. The part which
is at first nearest the fundus of the uterus is expelled in
advance of the head, which is primarily near to the mouth,
making a true natural turning — the "spontaneous evolution"
of Denman.

It would seem, however, that this author had an errone-
ous view of the process which really takes place, for he sup-
posed that the head rises while the breech descends; while

62 Eclectic and Summary.

the truth seems to be, as first pointed out by Douglas, that
the head does not rise, but while the presenting arm and
shoulder maintain their position, first the chest, next the ab-
domen, and then the breech and inferior extremities are
crowded past; the place of the doubling changing with the
progress of her labor.

From the anatomical obstacles to this process and the
great tax upon the powers of the patient, nature can not be
expected oiten to succeed in this attempt; and it is fortunate
that the presentation of the arm does not oftener occur, and
that in this case, artiiicial turning is generally practicable.

Ramsbotham in his large experience, saw but seven cases
of spontaneous evolution, and in several of these the child
was of diminutive size.

Dr. Robert Collins, in his work on midwifery, says that in
34.576 cases occurring in the Dublin Lying-in Hospital,
during his residence and that of Dr. Clarke in that institu-
tion, no case of spontaneous evolution occurred, with, per-
haps, one exception, which was reported by a midwife.

But this author seems, while writing, to have forgotten
that it would be unreasonable to look for cases of this spon-
taneous termination, while pursuing the uniform practice of
perforating and eviscerating the child in all cases in which
turning is impracticable.

Considering the uncertainty of the ability of the unaided
powers of nature to accomplish this result, the great hazard
to the mother from exhaustion and protracted pressure upon
the vagina and contiguous parts, and the certain death of
the child when of full size, it becomes a question whether
a pnysician, having the case in hand from the first, is justi-
fiable in awaiting their uncertain' result; whether it is not
his duty, repulsive as it maybe, to mutilate the child and
thus render its expulsion more easy and rapid, for the sake
of the mother's safety? — St. Louis Med. fy Surg. Jour.

Eclectic and Summary. 63

Phosphate of Lime. — Something Rich. — Pass it Round.

Verily,. there is nothing new under the sun. Even the
idea whick seems to come fresh from the coinage of a cre-
ative mind, is but a resurrection of the buried memory of a
thought that had laid in "cold obstruction" for centuries, and
the Phosphate of Lime finds its prototype in Album Graecum!
In the cause of science, a man must make some sacrifice of
modesty, and we will be excused by all liberal minded per-
sons if the adoption of a vulgar vernacular becomes neces-
sary in a dissertation upon the historical virtues of the Ster-
cus Canium Album; in plain English, white dog dung! Ac-
cording to authority, it consists almost wholly of Phosphate
of Lime, and was a long time since, thank God, esteemed
a marvellous remedy in many diseases.

Has any deep-seeking inquirer into the mysteries of hu-
man faith, ever learned the secret of that confidence which
is so strangely reposed in these stercoracious abominations
of the domestic pharmacopoeia. Even Dr. Dunglison, for
whom we entertain the highest regard, sets out dog dung in
his dictionary in all the priggish affection of Greek and
Latin.

Many there are in our generation, of those inspired block-
heads, who profess an instinctive knowledge of medicine,
and entertain a robust faith in the curative virtues of barn-
yard poultices; the cumfarty elecampane wizards, who ab-
jure doctor's means, do worlds of wonders with yarbs and
spells, and gravely tell you with an air of superior wisdom,
that sheep saffron is powerful for a sweat. We have an
oath registered on the records of early boyhood, which stands
with the accumulated interest of a good many years un-
profitably spent, against an old granny who watched us
through our spell of measles, and doctored us in despite of our
desperate resistance, with physic, which cost nothing more
than a daily walk to the sheep pasture. There are some
wrongs which time may palliate and reparation cure; but

64 Eclectic and Summary.

to sully the pride of budding manhood by a dose so diaboli-
cal, is an outrage of a die so deep, that, by the memory of
an outraged stomach, we can scarcely now muster christian
charity enough to forgive it, although its author has been,
for many years, in Abraham's bosom.

The last, freshest, foulest abomination that we have heard
of, was reported to us by our trusty friend, J. H. Would
that we could place his face and pantomime before our
readers, to aid the description which he gave us of the new
remedy. Our friend, in company with a companion, who
is also responsible for the truth of the narrative, was called
into some of the remote counties of the state, during the
latter part of the Summer on business. One of the districts
visited by them had been severely ravaged by dysentery, in
that fatal form, which, under the name of "bloody flux," has
filled so many graves in Kentucky.

The disease was talked of everywhere, and our friends
heard many remedies that succeeded in miraculously "cu-
ring every case after the doctors had failed." The crown-
ing essence was revealed to them by a host who had cured
several of his family, and took some himself by way of ex-
periment. We give this part of the story in the language
of the old gentleman, as it was reported to us by our friend.
"You must go out early in the morning, while the dew is on
the ground, to the hog-pen; look around and find the jinted
dung of the swine — no other will answer — take the middle
jints and bile them down to a syrup, and give freely for ef-
feet!!!" Compound concentrated syrup of hog d — g; war-
ranted to cure coughs, colds, cancers, consumptions, cramps,
&3., &c, &c. — Prepared after the process of the celebrated
BaronVon Thundermug! We have heard it gravely suggest-
ed, that quite anumber of the most celebrated quack remedies
are — between you and I, kind reader — composed of some of
the above elements. Think of that, ye dainty dyspeptics,
with your dinner pills and digestive fluids. Think, as the
sugar-coated pellet rolls over your gullet on its way to the

Eclectic and Summary. (55

gaping abyss beneath, that it may be a gilded deception,
and that an aromatic ball from one sheep's bowels is thus
on its road through those of a second. Your Pepsin, my dear
madam, and those nice homeopathic pillules, may be Album
Grsecum, after all that the chemist says about milk and
sugar; and, there, by the way, that fat gentleman has just
bolted an egregious bolus of the Comp. Cone. Extr. of H — g
D — g 5 supposing, innocent man, that it is, as its name im-
plies, a Comp. Extract of Sarsaparilla, or some other neu-
tral substance. Get the filth from your stomachs, gentle-
men, and, in future, beware of quack medicines. — Trans.
Med. Journal.

A new Method of Preparing Powders for use in Medicine.
Wittke, of Erfurt, recommends a new and very useful form
of powder. Tinctures, as is well known, generally possess
the most active properties of the drugs from which they are
prepared, but the amount of spirit which they contain often
renders their employment inadvisable ; Wittke, therefore,
mixes tincture of hellebore, of cinchona, &c, with an
equal quantity of sugar, evaporates to dryness, and pow-
ders the residuum. In this manner he succeeds in concen-
trating, in a very small bulk, the active portion of a very
large quantity of the drug, and he prescribes the powder as
saccharized cinchona, &c. These preparations bear some
analogy to conserves, over which, however, they have a great
advantage in being free from mucilage, vegetable albumen,
and other inert matters. — Dub. Quart. Jour. Med. Sc, Nov.
1851, from Vierteljahr shrift fur die prahlische Heilkunde,
Prag. 1851. Bd. 3.

66 Eclectic and Summary.

Influence of the Hour of the Day, on Births and Deaths.

Dr. Casper, the eminent statistician, has been led to the
following conclusions with regard to the influence of the
hour of the day on births and deaths. The observations
with regard to deaths are based upon 5591 cases. It would
be well if the physicians of our state could be induced to
adopt some plan by which statistical observations on every
subject interesting to physicians, and of course, through
them to the public, might be recorded for the benefit, if not
of our own age, at least of succeeding ones. Through our
state medical organisation we might accomplish much in
this way.

"1. As to Births. — More births occur from nine o'clock in
the evening to six o'clock in the morning, than during the
other hours of the twenty-four. Labor pains commence
more freqently between midnight and three o'clock in the
morning, than at other times. Of those births which termi-
nated during the day, the majority w r ere male children. La-
bor is longer if the pains begin in the day-time, than if it
commence during the night. This influence is more strik-
ing with still-born than with living children.

"2. As to Deaths. — The maximum general mortality oc-
curs during the earlier hours of the day, the minimum in the
evening. Of special causes of death, the relative mortality
w r ith reference to the time of day presents many variations.
Inflammatory diseases present their maximum in the after
part of the day; fevers and exanthemata in the earlier hours
of the night; hemorrhages in the fore part of the day, and
in the afternoon; and the neuroses, generally in the hours
after mid night ."' — London Med. Gazette.

Eclectic and Summary, 67

On the use of Tobacco Smoke in Strangulated Hernia. —
By Dr. F. J. Strattcw, of West Alexandria, Ohio.
H. K. about twenty-three years of age, of robust consti-
tution and athletic frame, had been lifting some heavy tim-
bers. When some hours subsequently, while engaged in
spading gravel, was seized with a most excrutiating pain
which he referred to the pubic region. His sufferings in-
creasing, Dr. Donnellan was called in, who at first took
the case for one of spasmodic colic. No relief being ob-
tained, he made a more thorough examination, which re-
vealed the true nature of the case.

I was now sent for, and found a strangulated hernia of
the inguinal oblique form, the tumor as large as a small pul-
let's egg and extremely firm. Efforts to reduce it by the
taxis were completely abortive, and caused the patient the
most exquisite misery. At this juncture, Drs. Dewey and
Lindsay came in, with whom, after a brief consultation,
about eighteen ounces of blood was taken from his arm,
without in any degree relaxing the rigidity of the tumor.
I now determined to try the effect of chloroform, rather
with the intention of affording the patient a temporary re-
spite from his sufferings than the expectation of accom-
plishing much towards the reduction of the hernia. The
violent struggling of the patient, the moment he felt the ef-
fect of the chloroform prevented him from receiving its full
anaesthetic influence, and often wasting about two ounces
in ineffectual attempts, it was abandoned. Previous to this,
in divided doses, I had administered 1 dr. tine, opii., with-
out any apparent effect. At the suggestion of Dr. Dewey,
it was now determined to try the full effect of opiate treat-
ments, and accordingly we commenced administering, ace-
tate of morphia gr. J, every half hour. In six hours the pa-
tient expressed himself as free from pain, but in no other
way exhibited the slightest influence of the drug. The tu-
mor was as firm as ever, and as it was now dangerous to
waste any more time in fruitless efforts at reduction, an op-

68 Eclectic and Summary*

eration seemed inevitable and for that purpose I prepared
my instruments.

Before operating, however, I determined as a last resort
to try the effect of tobacco smoke thrown up the rectum.
For this purpose a large sized gum-elastic catheter was ob-
tained and the open end inserted into the short stem of a com-
mon clay pipe. The connection was made air tight, by soft
ening and pressing down the wax at the end of the catheter.
The pipe was now filled with strong tobacco, ignighted, and
the catheter after being oiled passed up the rectum, the pa-
tient being on his elbows and knees. A strong muslin rag
was now applied over the bowl of the pipe, and an individ-
ual directed to apply his mouth to the same, and blow at
intervals as long as he could. In this way a large volume of
smoke was thrown into the bowels. In three minutes, the pa-
tient complained of nausea and a desire to evacuate his bow-
els. The instrument was withdrawn, and immediately a
large quantity of gas and some faeces escaped. Upon ma-
king an examination, I could now easily pass my finger cov-
ered with the sac of the scrotum into the external ring. The
tumor was soft — easily compressed, and reduced to one
third its former size. The patient was now placed in the
proper attitude, and a few moments application of the taxis,
returned the strangulated gut.

I might here remark, that injections and fomentations of
tobacco have often been used in reduction of strangulated
hernia, both in Europe and this country, but from its pow-
erful and sometimes fatal effects has justly fallen into disuse.
No such objection attaches to the use of the smoke of tobac-
co, while it relaxes the system as speedily and certainly as
tobacco in any other form, the effect is transient, leaving
but a slight degree of nervous prostration, which speedily
passes off. When tobocco by enema is administered in de-
coction more or less is taken up by the absorbents, and
some time must elapse before the system is free from its
poisonous effects. Not so with the smoke. The effect up-

Eclectic and Summary. 69

on the nervous system is rapid and complete, and as rapid-
ly passes away. Not however, until it has accomplished
all that can be attained by the relaxing agency. In the
above case, the patient was free from all the disagreeable
effects of the remedy in half an hour. I have little doubt
that the smoke of tobacco used as in this case related, will
succeed in nearly all cases where the tumor is large and
caused by gaseous distention or faeces, not hard and impac-
ted. I bring this case to the notice of the profession, with
a firm conviction, that by adopting in many cases the course
already detailed, a painful and serious operation will be
avoided. — Western Lancet.

Dr. D. J. Cain on External Diuretics.

In reporting the three following cases, illustrative of the
effects of external diuretics, I would remark that it must be
obvious that the coditions in which they are indicated and
would prove beneficial, are identical with those in which
their internal exhibition would be resorted to. In cases of
local or general dropsy, resulting from structural lesion of
the heart, liver, mesenteric glands, peritoneum, etc., their
effect can, as a matter of course, be but palliative.

The employment of diuretics externally, instead of in-
ternally, dates only a few years back. According to Dr.
Christison, the idea of substituting the one for the other,
originated with a French physician, who reported several
successful cases from their use. But it would seem that the
medical world did not adopt this mode of practice, for we
hear nothing more of the subject until the appearance of
Dr. Christison's paper, in the Edinburgh Monthly Journal of
Medical Science, of last November. With the contents of

70 Eclectic and Summary.

that communication, all present, are doubtless familiar. So
favorable was the opinion expressed by him, in reference to
their action, that I determined to use them in that manner,
in the first case of. effusion that should present itself to me.

I was soon furnished an opportunity, by a patient who
was admitted into the Marine Hospital, Jan. 28, '51 laboring
under extensive inflammation of the medius finger of the
right hand, with caries of all the phalanges, rendering am-
putation necessary. This was performed while he was in a
state of complete anaesthesia from chloroform.

While the healing process was going on, I perceived that
his abdomen began to enlarge, and on examination, fluctu-
ation was very evident. On inquiry into his antecedent his-
tory, I learned that his general health had not been previ-
ously very good; he had been troubled with diarrhea from
childhood, but he had had violent attacks, from time to time,
during the last five years, and his bowels were, at the time I
speak of, much disordered, the stools being more or less
fluid and frequent, and of a white or ash color, denoting 'n-
activity in the hepatic organ. He also told me that, about
four years ago, he had a hydropic collection in his abdomen,
for which he was treated in Baltimore, and from which he
recovered in about a month. I prescribed for him small
doses of taraxacum, with a view to its effect upon the liv-
er, and cinchona with iron, as a tonic. The swelling in-
creased to so great a degree, in the course of two weeks, as
to sensibly impede respiration. I now began the adminis-
tration of watermelon seed tea, and continued it for a few
days, without any great increase in the quantity of urine.
It was still scanty and red.

I then used the formula recommended by Dr. Christison,
viz.: equal parts of the tinctures of digitalis, squill and
soap, of which compound two drachms were rubbed upon
the abdomen three times daily. In forty-eight hours, the ef-
fects were manifested by a considerable increase in the
quantity passed. By the fourth day, I found him discharge

Eclectic and Summary. 71

ing between three and four quarts, by measure, which reach-
ed nearly five quarts, by the 7th, when the whole dropsical
collection had disappeared.

Ater keeping up the action of the kidneys for two or three
days longer, the diuretic was discontinued, and the urine
began to diminish in quantity.

It may be well to observe here, that, during the use of the
diuretic, I caused the patient to be restricted to about one
pint of fluid for the twenty-four hours — thus carrying out
the plan I have always followed in allowing the patient the
smallest quantity of drink, for the reason that, it the watery
portion of the blood is evacuated by diuretics, either alone
or by cathartics, and its place is not supplied by the intro-
duction of water through the stomach, the blood will become
inspissated, and, in accordance w T ith physical laws, an en-
dosmotic movement will go on from the rarer to the denser
flu:d: that is to say, the dropsical effusion will permeate the
tissues, enter the blood-vessels, (the veins,) and will be car-
ried into the circulation, where it will dilute the blood.

But, although the effused fluid had disappeared, the cause
was not removed, and, after an interval of about two weeks,
his abdomen again began to swell. I again resorted to the
diuretic, but this time with by no means such marked ef-
fects, the quantity of urine not being materially increased,
and, after using it about two weeks it was abandoned. I
then made trial of the digitalis, squill and colchicum inter-
nally, which was atttended by complete failure.

On careful examination of the patient, and from a con-
sideration of his antecedent history, I diagnosticated chron-
ic (perhaps scrofulous) inflammation of the peritoneum,
with perhaps obstruction to the portal circulation. The
fluid continued to increase, and tapping was had recourse
to in order to relieve him. About three gallons were drawn
off. It re-accummulated rapidly, and the patient died on
the — April. At the necropsy, we found extensive and vi-
olent inflammation of the visceral peritoneum; slight en-

72 Eclectic and Summary,

largement of several of the mesenteric glands; and, lastly,
an obstruction to the circulation of the blood through the
vena portse, caused by two large tubercular or scrofulous
masses.

From the lesions observed after death, (and which con-
firmed my diagnosis,) it is obvious that the diuretic could
have been of no permanent benefit.

Case IL — Peter Rose was admitted into the Hospital,
March 31st, 1851, laboring under intermittent fever.
Being at the time sick, Dr. F. P. Porcher, who visited it for
me, succeeded, in a day or two, in checking the fever. On
resuming my duties, a few days after, I found that his ab-
domen began to swell, and I soon detected fluctuation — as-
cites — due, in all probability, to the engorgement of the liver
and spleen, resulting from the repeated paroxysms of the
fever. Being encouraged by the succes that attended their
exhibition, the first time, in Case No. 1, 1 immediately re-
sorted to the use of the diuretics externally. The effect
was very prompt in this case as in the foregoing. In less
than forty-eight hours, the quantity of urine was notably
augmented, and, by the fourth or fifth day, he was passing
upwards of a gallon per diem. The hydropic accumulation
had entirely disappeared by the ninth day. This patient I
exhibited to several of the Counsellors of the South Caroli-
na Medical Association.

Case III. — George Bond was admitted Jan. 22d, 1851, to
be treated for congestion of one or both kidneys, with the
ordinary symptoms, such as discharge of blood, etc., the re-
sult, apparently, of cold. Cupping, blistering, soda, sweet,
spirits nitre, watermelon seed tea, digitalis, colchicum, etc.,
variously combined, was used as counter-irritants, and
as depletives of the kidneys, but with partial effect. I then
substituted the vegetable astringent, tannin, without any
decided benefit. I gave him turpentine, and, in a few days,
the hemorrhage ceased. From time to time, however, it re-
turned, from imprudence on the part of the patient, such as

Eclectic and Summary. 73

a fatiguing walk, getting the feet wet, etc., showing that the
congestion had not been completely resolved. In this state
of the case, I thought that the diuretics, externally applied,
might be of some service. They were used, consisting of
the substances above named, with the addition of colchi-
cum, which suggested itself to my mind as likely to assist
the action of the other ingredients. Its effect was soon shown
by an abundant discharge of urine; but, so great was the
action set up in the kidneys that it recalled the hemorrhage,
which ceased on the discontinuance of the diuretic.

I have also used it in two other cases, with decided advan-
tage: the one an old lady, who had an almost complete sup-
pression of urine, from indigestion, the other, a lady of mid-
dle age, who had anasarca from the impoverishment of the
blood in chronic diarrhea.

A medical friend informs me, that, at my suggestion, he
has employed it in a case of scarlatinal dropsy, and in three
other cases of effusion, from various causes, with happy ef-
fect.

The external application of diuretics possesses, it seems
to me, a manifest superiority over the internal use in this,
that it may be employed in all states of the system, without
causing any general or local disturbance, even if it does no
good. Every one is aware that the stomach is sometimes
so irritable or weak, or the bowels so relaxed, etc, no medi-
cines can be retained by it, or, if retained by the stomach,
they may increase the action of the bowels. Bevond this,
no advantage is claimed for the external over the internal
use. It appears, however, from one of Prof. Christison's
cases, that the diuretics succeded externally, when the same
combination failed internally.

I have watched closely, the action of the diuretics, when
applied externally, and have observed but the single effect
upon the kidneys.

The combination recommended by Prof. Christison is a
good one; but other substances may be added, or they may

74 Eclectic and Summary.

be combined in different proportions. To the tinctures of
soap, digitalis and squills, may be added vin colchic, tinct*
cantharides, etc.

I have deviated somewhat from the quantities and the in-
tervals spoken of by him. He used but 2 or 3 dr. of the
compound, rubbed upon the abdomen three times daily. In
two of the cases above reported, I ordered from i to 1 oz.,
four, five, and even six times in the twenty-four hours. In
one case, Prof. Christison simply applied a linen rag, satu-
rated with tincture digitalis, upon the abdomen, and with
equally marked benefit.

I have observed, while experimenting with diuretics in
this way, the fact, that when they fail externally, (as they
have, in two or three instances, since the above cases were
treated,) the same, or other combinations, invariably fail in-
ternally.

In mentioning this circumstance to two medical gentlemen
of this city, they remembered that the same thing had oc-
curred in their trials with them. Thus, it would seem, that
the kidneys are sometimes wholly insusceptible of the influ-
ence of this class of agents. — Charleston Med. Jour.

New Mode of Disguising the Taste of Cod-Liver Oil,
Dr. Routh exhibited to the Medical Society of London, a
specimen of "Sardine-flavored oil," prepared by digesting a
number of sardine fishes, as sent over from Italy, in some
cod-liver oil. After a month or so, the oil acquired the taste
and smell of the sardines, and was very pleasant to take;
spread over a piece of hot toast, it formed really quite a lux-
ury. The bottle was handed round, and seemed to give gen-
eral satisfaction. — Charleston Med. Jour.

Eclectic and Summary. 76

Who first Amputated the Lower Jaw?
To the Editor of the Boston Medical and Surgical Journal:

Sir: — In the New York Journal of Prledicine for January,
1852, it is stated, and that too, by an American surgeon hav-
ing some claim to distinction, that, "To Dupuytrcn was re-
served ihe glory of having, in 1812, first removed, by a me-
thodical operation, a portion of the body of the inferior max-
illa." If by this, we are to understand simply, that the first
time the French surgeon performed this operation, was in
1812, very well; we do not dissent, but accord to him all the
glory that he deserves for his surgical skill and daring. But
if, as is the more probable, the writer means to assert that
Dupuytren, in 1812, performed the first operation of this
kind ever made on the lower jaw, we deny the assertion
with astonishment that a professor of surgery, in a city
where such abundant means are at his command, of acquir-
ing correct information in regard to facts that have now be-
come land-marks in the history of surgery in this country,
should make such an unwarrantable blunder. He is either
utterly regardlessof the honor due his countrymen,and capti-
vated by the prestige of a great name, or strangely ignorant
of the history of that science in our country, which he pro-
fesses to teach.

But to the proof. Prof. C. correctly states, that Dupuy-
tren performed his operation in 1812. But if he will refer
to the American Medical Recorder, Vol. VI., p. 516, he will
find the report of a case of "Removal of a portion of the
Lower Maxillary Bone, by W. H. Deaderick, M. D., of Rog-
ersville, Tenn." This operation purports to have been per-
formed in 1810, thirteen years previously to the date of the
report of the case. Now, if ten from twelve leaves two,
why it is plain that all the glory which the learned profes-
sor is disposed to reserve for the tardy French surgeon, is
due our own ingenious countryman. And he has received
this glory from those most capable and worthy of bestow-

76 Eclectic and Summary,

ing it, both at home and abroad. Dr. Mott acknowledges
the case, in a note to his letter to Dr. Liston. (Mott's Vel-
peau, Vol. II., p. 917.) Dr. Smith (A System of Operative
Surgery, &c, Part ]., p. 38) remarks of it as "claiming
justly to be the first operation of the kind ever performed,
being two years before that of Dupuytren." Mr. South
(Cheliu's Surgery, Vol. III., p. 745) says: "As will be pres-
ently seen, Deaderick was the first who, in 1810, cut away
the side of the lower jaw; in 1812, Dupuytren sawed off a
large portion of the front of the jaw." Again, p. 749,
''Deaderick, of Rogersville, Tenn., is justly entitled to the
merit of having first, in 1810, amputated a portion of the
jaw of a child of 14, &c."

Having thus given to Dupuytren the glory of the first
amputation of the lower jaw, without even alluding to the
claims of others, he thus summarily disposes of the claim of
Walther, of Bonn, of being the first to remove the entire
lower jaw, and like the great French surgeon, walks off
with the glory in reserve for him. "In the Annals of Surgery
there is an allusion made to the amputation of the entire
lower jaw, by Walther, of Bonn; but I have not been able
to trace the truth of it to an official source." What is meant
here by official, we do not know; but if standard authorities
are to be believed, Walther, of Bonn, did perform such an
operation. Malgalgne not only notices, but describes the
different steps of his operation, in his work on Operative
Surgery.

We conclude by commending to the consideration of Prof.
C. the following just reflections of his venerable preceptor.
"We can not permit ourselves to believe that any surgeon of
rank, possessing the high moral character which it is pre-
sumable should, or we might say, must necessarily belong
to at least the distinguished members of the medical profes-
sion, as the guarantee of eminence and respectability, would
willingly or wilfully deprive another of the honor that be*
longs to him."— (Mott.) J. C. 0.

New York City, Jan., 1852.

Eclectic and Summary. 77

Hepatico-renal Circulation. — Discovery byM. Bernard.

We find the following announcement in the American
Journal of Medical Science, for July. M. Bernard has dis-
covered the existence of a communication between the por-
tal vein, the ascending cava and the kidneys, by means of
which the urine is secreted from the blood which has not yet
passed through the general circulation. This communica-
tion explains the rapidity with which substances taken into
the stomach find their way into the urinary secretion, and
also how it is, that poisons taken into the alimentary canal,
are sometimes fatal and at others not, as well as why the
presence of certain substances given to animals should be
detected in the blood at one time, and not at others. Ac-
cording to his view, "the renal veins have a double duty to
perform; during the time of abstinence they conduct the re-
turn circulation from the kidneys; during digestion they act
as arteries, just as ihe pulmonary veins do for the lungs, and
the portal veins for the liver. In effect, during the reflux
of blood mentioned above, there is a distinct pulsation per-
ceivable in the cava and in the renal veins. This, though
difficult to show, yet may be seen by killing a rabbit during
digestion, and opening immediately the abdominal parietes.

As M. Bernard remarked, when one reflects upon the
matter, it is not so much to be wondered at, if we recollect,
that in fish and in reptiles there exists a porto-renal vein by
which a certain quantity of blood passes directly to the kid-
neys from the mesenteric veins, only a portion being sent to
the lungs. — Western Lancet.

Tannate of Quinine in Intermittent Fever.
M. Lefevre, of Rochfort, communicated statistics which
went to show that the tannate does not possess powers su-

78 Eclectic and Summary.

periorto the sulphate of quinine in arresting ague. It is,
however, more certainly retained by the stomach, and less
frequently produces derangements of the nervous system. —
Western Lancet.

M. Chailly-Honore on Compression of the Aorta in Uterine
Hemorrhage.

M. Chailly-Honore considers that this practice is not re-
sorted to so frequently as from its merits it deserves to be;
and believes, that had it been employed in one or two cases
in which transfusion has been lately performed, it would
have rendered that dernier resort unnecessary, or would
have enabled it to save life when employed. Rudiger per-
formed compression so long back as 1797; but Ulsamer
first advised its being applied through the wall of the abdo-
men in place of through the uterus. The practitioner stand-
ing at the left side, passes his right hand between the uterus
and intestines, seizes the vessel between the index and me-
dius finger, fixing it firmly against the vertebral column,
and pressing on his right with his left hand. If in thirteen
cases in which this practice has been resorted to, half the
women died, this arose from its being deferred until they
were in extremis, and all other means had failed. To these
cases M. Chailly opposes eighteen others, occurring in his
own practice, and among which only one woman died, in
whom, also, the application had been too long delayed. In
«ome of these compression was maintained for two hours
without inconvenience. In the former series of cases, the
compression was delayed too long, and employed without
rule, cofidence, or patience. In the latter, it was resorted to
in time, and mathematically continued. Of course the prac-
tice is not advocated as curative, but as a means of gaining
time in an emergency, wherein time is every thing. — B. and
F. Med.-Chirurg. Review.

EDITORIAL,

SALUTATORY.

It is hardly necessary to make an apology, for adding an*
other, to the extensive and increasing list of Medical Jour-
nals. The dissemminafion of correct professional views,
practical and ethical — throwing them broad-cast over the
land, that they may penetrate into every cove, and ascend
every knob, where disease and accident have followed the
adventuring energy of man, can not be undertaken by too
many, nor too zealously prosecuted by those who enter up-
on the attempt. The object, though difficult in attainment,
is laudable in prosecution, and demands the active co-ope-
ration of many laborers.

The time has not long past, when a newspaper was a
visitor to but few families of a country neighborhood, and
they were dependent for that, upon the larger towns of their
own, or other states. But now, almost every county seat
of every state has its own journal, to record and preserve
the occurrences of the little community in which it exists,
in connection with the events of the great world. And the
effect is evident. Intelligence and etiquet are not now,
as formerly, confined to the few — they are as common to the
country as the town; the city gentleman meets his equal in
mind and in manners, when thrown in company with his
friend who resides away from the din and advantages of the
large commercial marts, and the city lady no longer laughs
and blushes because of the ignorance and awkwardness of
her visiting country cousin lass. The men, women, and
children, all read, being forced to it by the multiplication of
these weekly messengers, telling the news of the latest ad-
vance or change in Government, Religion, Morals, the Arts
and Science.

80 Salutatory.

And this must inevitably be the effect on medical men, by
the multiplication of journals devoted exclusively to pro-
fessional matters.

At present, want of reading, is the sin of the profession;
and in our vision, we can discern no means for its destruc-
tion, so effectual as offering, from as many points of the
compass as maybe, weekly, monthly and quarterly messen-
gers — placing at every turn, a printed record of what is
doing in the great professional circle. A newspaper has
never yet been successfully established, that it did not cre-
ate a demand for another. And the same, we think is true
of professional journals.

But another reason is with us more mighty. It is strictly
a professional reason, but its effectiveness depends upon the
truth of the general views we have expressed. From cir-
cumstances, we are led to the opinion that the publication of
such general works as those ordinarily issued from the press
under the euphonic title of "Practice of Medicine," have
done much to quiet the sensibilities of practitioners, and
hence to lull their spirit of investigation. The conglomer-
ation of Anatomy, Pathology, Physiology, Symptomatolo-
gy, and Formulary, presented in these works, though of use
to the diligent student as matter of reference, offer to the
indolent and the interloper easy access to the confidence of
the people. They can at best, even when as extensive as
Good's Study — and we might introduce the names of later
publications — but be deficient in some, as they are in many,
important particulars. The indolent and the interloper seek
not for knowledge — they want nothing but precedent. The
"Divine Idea" of Fichte, the moving impulse to grand at-
tempt and noble achievement, is in them dormant or per-
verted. But present them with a journal questioning the
correctness of observation, and denying the appositeness of
the reasoning sustaining the precedent which governs
them, and conscience will be aroused, sensitiveness of re-
sponsibility quickened, and the spirit of enquiry awakened,

Salutatory; 81

Independent thought will spring into action, research
will be undertaken, the "Practice of Medicine" will be
thrown aside except as reference, or as an index for the
direction of investigation, and works on special subjects will
be sought after. Thus it is, the journal becomes the medi-
um of communicating an onward move. But it is not here
its work is finished. Every practitioner makes observations
on every subject embraced in the wide-extended circle of
medical investigation, "for medicine comprehends within
its cycle many collateral sciences." These are too meagre
for a volumn, but yet it possessed by another who has ac-
cumulated a mass of observations on the same point, would
do good service. They, therefore, merit preservation, and
the pages of the journal present themselves as archives.

But why record here any more of the very many reasons
for increasing the number of medical journals? For "hoW
can a medical man succeed in the great competition which
exists in the profession, unless he feel conscious that he treads
upon firm ground, and possesses not the ostentations, but the
absolute knowledge which is necessary for the treatment of
disease?" And how can he possess this knowledge without
reading? and how can he know what to read unless he sup-
ports the journals?

But to conclude. In the language of the committee of
the American Association: — "Local publications induce
many persons who would not think of approaching the more
distant journals to record their observations and reflections;
# # # # # # and they tend to unite the feelings and
action of the physicians within the regions where they circu-
late, and in this manner, to promote the interests of the whole
profession."

To this quotation, we particularly invite attention from
the physicians of East Tennessee. We anxiously desire
them to note well the varying circumstances of disease,
and the result of treatment, occurring in their practice, and
forward to us for publication; and most earnestly do we be-

82 American Medical Association.

seech them to permit "The Record," as we devoutly pray
it will, "tend to unite their feelings and action."

For twelve months, quarterly, the Record will certainly
be issued, and we hope for a much longer period. But this
of course, will depend on the energy of those in obtain-
ing subscribers, under whose auspices the Record has com-
mencement, and who have sent us the few hundred names
which we now address. We have on hand, some com-
munications, or papers, which belong to the East Tennessee
Medical Society; but as yet, we lack material sufficient for
the second number. It will be put to press the second week
of June, and wc hope that our friends will forward their
communications, so that they will come into our possession,
during, or before the first week of that month.

RELATIONS OF THE AMERICAN MEDICAL ASSO-
CIATION TO THE GENERAL PUBLIC.

The American Medical Association, as the great Congress
of the Medical Republic, must exert a happy influence. And
this influence can not be restricted to the professional com-
munity, of which the Association is the representative, but
must affect the public at large. Hence, the opinions and
suggestions which emanate from a body of such importance,
should be, for the most part, zealously sustained by medical
rrlen, with the hearty co-operation of the general public.

The educated physician may be humiliated, and yet his
interests not be materially effected, by the fact, that annu-
ally a host are diplomated Doctors, who are, in every par-
ticular, essentially unfitted to discharge the duties of the
most difficult of all professions. True, occasionally a wor-
thy physician is made to feel the bitterness of chagrin, or

American Medical Association. 83

even the bitings of penury, from <he misjudged bestowal of
confidence, upon some more presuming and more ignorant
practitioner. But ordinarily the uneducated physician ex-
erts an influence commensurate with his attainments; and
but for his profound respect for the nobleness of his calling,
and appreciation of the sacredness of the responsibilities it
involves, he would take no thought of the ignorance which
prevails. The educated physician does not feel for himself
when he sees a fellow being under the professional charge
of one, whose attainments he knows, are not adequate to
the discharge of the duties assumed. He feels, and deeply
too, for the absence of that quickness of conscience, which,
if present, would prevent the disqualiued practitioner from
the bold presumption of daring to risk a violation — aye,
many times — of the sixth commandment. He feels sorrow,
that lor the want of an efficient criterion* his fellow-mortals
are so frequently subjected to imposition. Not for himself,
but for others is his anxiety aroused, and his exertion put
forth in all its vigor. Such feelings found place in the
breasts of very many practitioners, and gave origin to the
formation of the American Medical Association — a body in
whose action the general public is deeply interested. The
lives and health of the individuals of society who repose
upon medicinal agents and hygenie advice given by
the practitioner of physic in whom they repose confidence,
are the stakes. Fearful, horribly fearful is the hazard; and
it well behooves those who have so much to lose, or to win
and to keep, to see to it, that the man they have selected is
fitted for the trust reposed in him.

The fact has Jong since been proven, that the public re*
quires a guard against imposition in medical matters; and
every day but gives it new illustration. Arrogant assump-
tions of superior attainments, clear perception, and profound
judgment, are received by many, with but a wavering doubt;
and others are deceived by practitioners encasing themselves
in haul — crying, "I am, Sir, Solomon;" and for reasons which

S4 American Medical Association.

are obvious to some, declining intimate, or even occassional
association with other medical men. But by far the largest
majority, take medical advice from an appreciation of the
value of experience, but without a correct apprehension of
what constitutes true experience.

Age, though it presupposes, does not necessarily carry
with it experience. Personal observation must be corrected
and confirmed by the observations of not a few. but many
others, before an experience to be confided in and re-
spected, can be claimed.

Not one of all the heterodox systems of medicine which
have fallen, or yet exist, has failed to make its appeal for
support on the ground of experience. Thompson, the found-
er of the exploded system of steaming, on determining to
devote his time wholly to the practice of medicine, says: "I
found it necessary to fix on some system or plan for my
future government in the treatment of disease; as my
practice had been the result of accident, as it were, and
the necessity arising out of the particular cases under my
care, without any fixed plan. * * * * *
I took nature for my guide, and experience for my
instructor." And though the practice was the result of
accident, it was boldly employed, and was received with all
the honor and confidence due a legitimate, and long and va-
riously tried and proven observation. And Eclectic Medi-
cine — the smouldering ruins of Thompsonianism — yet gives
echo to its founder's cry of experience. Hahnemun, too,
the father of the weak delusion, HomoBpathy, lays claim to an
alliance with nature, and appeals to experience; indeed, he
cfalis it "The Medicine of Experience," and affirms that "the
results of this method so contormable to nature, are infal-
lible." So, too, with Hydropathy, and every other system
which injuriously affects the vital interests of man, the tal-
ismanic word is — Experience. In the advertising depart-
ment of newspapers it is seen again and again. The claims
of the different Vegetable Pills. Ointments, Liniments, Life-

American Medical Association. 85

bitters, Pectorals, Compound Extracts, and Syrups, are com-
prised in the single word, experience. And yet the fact
that these systems exist but for a short time, and then pass
away to be forgotten, or may be, after many years, revived
again by designing men; and that the patent medicine of
the present year has supplanted one which was fully as
much confided in twelve months ago, and will itself have
but a brief sway of public favor, shows that the professed
experience is but an appearance, and that the public does
not know, or if not ignorant, is careless in distinguishing a
true experience.

The practitioners who rely on their individual observation,
uncorrected or unestablished by extensive comparison with
the observation of others, are aptly touched off by Sava.
He says: "Some physicLms become machines as they grow
old. * * * Obstinately attached to their old doctrines,
they will vary nothing; every thing new they treat with dis-
gust and disdain, and thus they never read. After fifty
years of medical practice, it is impossible for them to
adopt other principles, different from those the} 7 have acquir-
ed, and been accustomed so long to follow." And a promi-
nent writer has said: "Medical practitioners may number
up many years, and yet remain the merest mechanical
drudges; their experience, as it is called, having tested the
endurance of their bodies, instead of storing their minds."

Again, the reputation of success, has, time and again, sus-
tained practitioners who were wholly incompetent. It is
impossible for the public to judge correctly of the success
of a practitioner. Indeed, the practitioner is sometimes de-
ceived himself. Minor says: "The most unsuccessful accoucher
I ever knew, who probably destroyed more unborn infants,
than any other ten practitioners in Connecticut, flattered
himself and his employers that he was peculiarly skillful."
The public never think of the fact, that by chance, one prac-
titioner may have a number of very malignant cases, at a
particular time, while the cases of another with whom he

SG American Medical Association.

is compared, are all mild. With the public, death is the
evidence of non-success; and recovery > of success; for if it
is known, it is not usually remembered, that the seemingly
most simple attack may prove beyond the skill of the most
sagacious physicians, as witness a case referred to during
the past year, in the Charleston Medical Journal. This pa-
tient presented no symptoms ot serious import, and yet a
post mortem exposed such pathlogical conditions, as would
have rendered recovery hopeless, had they been recognized
during the life of the patient. And it is not generally known
or remembered, that cases apparantly desperate sometimes
recover, though the most injudicious, even bordering on per*
nicious, plan of medication be employed, as witness the re*
ported cases of Puerperal Peritonitis treated by enormous,
and frequently repeated doses of Opium, in New York*
The only true criterion of success is one, which, under ex*
isting circumstances, can not be of particular advantage to
the public. It was enunciated many years ago, in a tract
ascribed to Hippocrates, entitled, "The Places in Men," and
is embraced in the following quotation from Adams, the
learned editor of Hippocrate's works. Of the author of
this tract — "He estimates successful and unsuccessful prac-
tice according to the rule whether the treatment was right-
ly planned or not; for, he argues, what is done in ignorance
can not be said to be correctly done, even if the results are fa*
vorable."

Ask the imposter, the poorly educated practitioner, why
he does not study, why he does not familiarize himself with
the knowledge which should be possessed by him who pre-
sumes to deal with the subtle thing called life? If candor
be an element of his organization, he will answer, "I can
get practice without, and therefore it is unnecessary." Ask
the patentee of a nostrum, why he makes useless, or if at all
active, dangerous compounds, and advertises them in news-
prints, and hand-bills, and almanacs, with so much dishon-
est show of success? If a thing so pure as truth can ema*

American Medical Association. 8T

nate from such rash viciousness, he will reply — "I can excite
the confidence of the people, and am willing by doing so,
and abusing it, to accumulate wealth?"

These are all facts which should be held prominently and
constantly before those who look to medicine for prolonga-
tion of life, or for comfort, during the moments or hours
of the agony of death — facts which the public can be made
to appreciate, if properly presented by the members of the
noble profession "whose end is good to man." And when
this appreciation is attained, that public will ask for some
criterion, some safeguard, by which it will be enabled to
avoid ignorance and cupidity in the search for healing means
and soothing agencies. This criterion and safeguard is now
offered them in the assertions, resolutions, and recommen-
dations of the American Medical Association. Let these
be placed before the public by practitioners, and compara-
tively but a few years will be necessary for them to be ef-
fective in changing the whole character of the profassion,
filling it with men emulous to encompass all nature, for the
purpose of qualifying them for the grave responsibilities of
medical practitioners.

What are these? First — By the very organization of the
Association, is expressed confidence in the truth of the trite
words, "in union is strength." And the preamble to the ar-
ticles of organization, asserts that co-operation will "sup-
ply more efficient means than have hitherto been available
here, for cultivating and advancing medical knowledge, for
elevating the standard of medical education, for promoting
the usefulness, honor and interests of the medical profession^
and for enlightening and directing public opinion in regard
to the duties, responsibilities, and requirements of medical
men, <J*c." And carrying out the idea, the Association re-
commends by formal resolution, the formation of State,
District, and County Medical Societies. And why has this
recommendation not been more fully complied with? The
answer is to be found in the absence of impulse derived from

88 Amei tcan Medical Association.

the people and given to medical men. The public fully ap*
predates the fact that "in union there is strength," and is
capable of perceiving the beneficial influence of associa-
tion on practitioners of medicine, as well as on any other
particular class of men. But so long have practitioners
been considered as individually antipathic, that the idea of
their being made gregarious is slow in being possessed by
the public mind. But let physicians publish and re-publish
the affirmations and recommendations of the Association; let
them urge, without faltering, the necessity of county, and
state, as well as national organization of the members of
the profession, and after a time, the rich fruit of such labors
w r ill be an abundant harvest. The public will, sooner or la-
ter, see that such organizations will be to the great advan-
tage of society in general, as well as to the medical profes-
sion and its members individually. And it will naturally,
irresistibly enquire why such and such a doctor does not be-
long to the county, or district, or state society, through which
media he may attain to membership in the National Asso-
ciation? And this same public will answer the question,
and no odds what may be the personal, political, sectari-
an, or family influence, which sustains such practitioners,
they will discover that the answer adds nothing to their
reputation, while it prevents an extension of, if it does not
contract the boundaries of their fields of practice, and di-
minish the cash value of their professional labors; and this
realization attained, they will zealously assist in the organ-
ization of, or anxiously knock to be admitted in the socie-
ties.

]Let physicians give frequent, united and emphatic express
sion to their views, enlightening and directing public opin-
ion in regard to the duties, responsibilities and requirements
of medical men," and that public opinion, will caus j medi-
cal societies to be organized in every state, territory and
county of this extended and extending country.

Second : Physicians should place and keep before th©

American Medical Association. 89

public that the Association, at different times, and in varied
language has affirmed, that "the system of medical education
is this country is defective" and has pointed out, suggestive-
ly the way in which the evil may be remedied. The day
has passed when facilities for medical education were hard-
ly, attainable in this country; and, therefore, the necessity
which at one time existed, of men assuming the discharge
of the duties of practitioners from merely reading forsooth
a course of medicine, does not now prevail. Almost every
state has one or more colleges constituted of a faculty of
medicine — men who propose to induct the aspirant into all
the honors of the doctorate, after an attendance for eight
months on lectures. But this <eight months the Association
declares to be too short a time for a man to acquire famili-
arity with the subjects embraced in medicine. And in con-
nection with this, let it not be forgotten to publish the fact
that a diploma is but prima facie evidence that its possessor
is a qualified medical man; and that almost every Medical
College in the union offers an inducement to young men to
assume the discharge of the duties of practitioners, before
possessing even the little weight of dignity given by the di-
ploma. This parchment is held forth as the prize to be won,
and time and money only are necessary to its attainments
"Eight months, and two hundred and fifty dollars, or less — -
or if the conditions are not satisfactory, propose for practice,
wait four years; and then four months^ and one hundred
and thirty dollars, or less, will be received" constitutes a free
rendering of the terms which we read in the annual an-
nouncements sent forth by the different medical colleges
of these states. For, while the public should know that the
Association deprecates the assumption of the duties of the
physician, without the possession of some testimonial of
qualifications, from a reputable and legally organized Fac-
ulty of medicine, the fact should not be suppressed that the
Association also emphatically declares that the testimonial
is too freely given — too easily attained, not truly without

90 Amei lean Medical Association.

mono}' and price, but in by far too many instances, by indi-
viduals, without original capacity, educational acquire-
ments, or professional fitness. And further, the declarations
of the Association, that dissections of the human body, and
an efficient attendance on hospital practice, are essentially
necessary, superadded to the college instruction, to the qual-
ification of any one for the intrinsically, if not ordinarily
esteemed difficult and responsible position of medical ad-
visor, must not be forgotten. Let these facts be published,
and their publication reiterated, and the time will assuredly
come when the public will give no countenance to those
who assume the discharge of the duties pertaining to the
doctorate; and when the parchment of a medical college
will be received by non-medical as well as medical com-
munities, as an evidence of facilities having been en-
joyed and rightfully employed, which entitle the proposers
for confidence to esteem and respectful consideration.

Third : Let the practitioners obtain the Ethics of the pro-
fession as adopted by the Association, and distribute a copy
to every family to which they sustain the relation of medi-
cal advisors; and this will serve as leaven, for the mass, ex-
pediting the approach of the death-day of empiricism,, and
the dawning of the natal day of that fraternal feeling in the
profession which will be characterized by the "noble emu-
lation of who can best work and best agree."

The Association has affirmed much, recommended much,
and resolved strongly; and here and there over the country
the impress of its influence is perceptible. But its affirma-
tions, recommendations, and resolutions, cannot be signally
effective until they are widety disseminated, and famil-
iarized to the general public. We hope, therefore, that the
Association at the session to be holden next month, will
maturely consider its relations to the public, and adopt some
efficient plan for "enlightening and directing public opinion
in regard to the duties, responsibilities, and requirements of
medical men.'' 9

Clerical Interferon < 8 1

CLERICAL INTERFERENCE.

Prop. Bond, of Baltimore, asserted before the American
Medical Association, daring its session at Bosljpn, that "the
influence of a popular clergyman is worth more in com-
manding practice than the diplomas from all the different
schools of the country." And of the four or five hundred
medical men there, not one denied the assertion. That the
fact is well appreciated by those who avail themselves of
such extrinsic aid, we are well assured. A doctor who does
not possess more than a modicum of general or profession-
al acqirements, when contemplating a removal to the rap-
idly growing city of Memphis, told us that he by no means
desired any better ground for preferment, than the promised
influence of the pastor of a congregation in that city.

But these are but reiterations, and are not necessary to
impress upon the minds of the medical fraternity the' fact
of illegitimate interference on the part of preachers. Nor
can its frequent reiteration, however varied the language in
which it is conveyed, produce a favorable change; such a
change must result from the steady prosecution of a line of
policy, determined upon for the purpose of meeting all the
exigencies involved.

And what should be the nature of that policy — oppositive
or conciliatory?

To our mind, the latter seems the most natural, and there-
fore the most promising of effective influence. The minis-
ter of the Gospel — intrinsically such — conveys the balm of
Gilead to the sin-sick soul. The practitioner of medicine
fills a no less important, and scarcely less glorious minis-
tration. He directs the application of the instruments of
healing to the diseased or broken body, and lays down hy-
gienic precepts, for its preservation in that degree of vigor
and comfort which are essential to it, as the soul's tenement,
for the reception and manifestation of correct spiritual in-
fluences.

92 Clerical Interference.

The vocations, then, are far from being opposed; and it
is not meet or right, for those filling them, to occupy the po-
sitions of antagonists.

^ Although the action against which complaint is laid is to
be deprecated, we are not amongst the number who regard
it as an evidence of hostility on the part of preachers to true
medicine. We rather believe that those who are amenable to
the censure of medical men, have left too much, the weight-
ier matters of the law, and given too great attention to the
abstract spiritualism of Faith — thus generating a weakness
which is designated as credulity; and which prevails alike
with priest and layman, in proportion to their want of
general knowledge.

Having thrown aside the connection existing between the
former and latter dispensations, disregarding the law, and
depending wholly on grace, they have forgotten that the
Faith, which is the substance of things hoped for, the evi-
dence of things not seen, is rational, and when exercised
vigorously the law is clearly apprehended, and strictly ob-
served. And thus they have sunken into credulity, which
is blind; and when asked, are unable to give a reason for the
faith which is in them; but boldly and strongly cry, Faith!
Faith! Experience! Experience!

The dogma of sect becomes the sole, the undivided idea
of those who perform the ministerial duties, and prevents
comprehensiveness of thought, restricts the scope of mental
vision, perverts the judgment, and induces disingenuous or
illiberal conduct.

These results pertain not to the medical philosopher or the
le'arned theologian. The nature of their studies, the cycle
of sciences with which they must be more or less familiar
— all tending to the one single object of understanding the
nature of man, make them intimate with the dependence
of grace and law, of faith and works, of spirit and matter.
True, the Physician and Theologian investigate for different
purposes, but before attaining their respective objects they

Clerical Interference. 93

must necessarily view the same ground. And though each
may have different trains of thought, we apprehend the
same expansion of mind with all its attending influences
will be produced — just as the same landscape, though dif-
ferently appreciated, universally causes the comfortable sen-
sation of elation.

We venture the assertion that no one can successfully
sustain against a physician, the charge of bigotry — of the
exercise of intermeddling efforts, induced by a blind zeal to
have others adopt his religious peculiarities — of entertain-
ing that fanatical selfishness which confines social inter-
course and intimacies to the limits of the denominational
boundary. No! The Physician adopts his own conclusion
on the vital questions relating to his immortal existence, and
makes choice of his religious associates, and never permits
his denominational preferences to exert an influence on
his estimate of social or professional qualities.

It was a learned and good theologian who said — "There
is naught that contributes more to the soundness of one's
philosophy, than an accurate perception of the limit be-
tween the known and the unknown, or rather, between the
knowable and the unknowable." And it is a truism, that
"he's the most liberal who is the most philosophical." The
liberality of the Physician proceeds from this fact, that the
studies his mind is forced to be occupied with, and the points
presented every day for reflection, lead him more nearly, in
accordance with individual capacity, to a perception of the
line of demarkation between the known and unknown. And
as these studies are the same as those which occupy the
mind of the deep, penetrating theologian, it follows that
those who "stand in Christ's stead," and yet exercise an illib-
erally unbefitting the position they have assumed, have not
set themselves sedulously to the work before them, and with
an eye single to the object in view. That indeed, they have
not only neglected to encompass all nature, and enquire af-
%qx the knowledge of the intricate machine for whose spir-

91 Clerical Interference.

itual and bodily salvation for all eternity, they express so
much desire; but they have also failed closely to study the
pages of that Holy Book from which they profess to teach.
For does not Peter tell them, 'Let none of you suffer as a
murderer, or as a thief, or as an evil doer, or as a busy body
in other men's matters' "

This, then, is the policy we suggest. Whenever any
preacher is discovered to have forsaken his own path of du-
ties, and to be exerting his official and professional position
to the detriment of true medicine, or to the advancement of
disqualified practitioners of the art, beseech him to add to
his faith virtue, and to his virtue knowledge; and we may
rest assured, upon his attaining this "one thing," that tem-
perance, patience, godliness, brotherly-kindness and charity
will be in him and abound, so that he shall neither be barren
nor unfruitful in the work in which he is engaged. And we
must remember, that so long as he "lacketh these things, he
is blind, and can not seje afar off," and therefore we must
"not weary in well doing. And if he obey not our solicita-
tion, let us note him, and have no company with him, that
he maybe ashamed; yet not counting him as an enemy, but
admonishing him as a brother."

Drake's Discourses. 95

DRAKE'S DISCOURSES.

We have been permitted the pleasure and benefit of read-
ing "Discourses delivered by appointment, before the Cincin-
nati Medical Library Association, Jan. 9 — 10, 1852. By
Daniel Drake, M. D."

We wish that our readers could enjoy these ninety-three
pages, consisting of an old and worthy physician's recollec-
tions of medical men, who lived in Cincinnati from the first
impress on its soil made by the feet of the Pale-face, until
it has become a commercial mart, and its throughfares
crowded by thousands; and of the "Periodical Literature of
the Profession," which he dates from the year 1722, when
it consisted of a single annual, until these times, when it is
presented in such rich profusion. And we would be glad to
know that the heart of every medical man responds in
symphony to the noble sentiments which the author has
taken occasion frequently to express throughout the dis-
courses. The publication is inscribed to Prof. Dickson, of
Charleston, to whom Dr. Drake says: "I wish to manifest
what I feel and think, that neither difference of age, nor dis-
tance of place, should be permitted to break up the unity, in-
tegrity, and kind feeling of %ur beloved national prof ession."

And, again, in the first discourse, by pretty comparison,
he enforces his sentiment of the mutual dependency of med-
ical men — "The root of the family tree connects all the
branches; so that people of the same stock, however widely
dispersed, fraternize, when on casually meeting, they discov-
er a relation to the same genealogical tree. Now, the phy-
sicians of every city make one professional family, and
have a common ancestry. To this relationship of our pro-
fession, I wish now to draw your attention. I desire to make
you feel and believe; no, rather let me say, I hope you al-
ready feel that we constitute one brotherhood, going back
to the same ancestral root, and looking forward to the pro-
gressive rise of a common glory."

96 Drake's Discourses.

Again, in perfect accordance with the feeling which dic-
tated the expression used by Sydenham when writing to
Brady — "Those who hold that it is no matter what happens
after them, hold a wicked and inhuman doctrine" — Drake
beautifully tells us the enlightened aspirant for medical dis-
tinction is but little taken with the applause of the present
moment, unless he perceive, that after it has passed away,
there will remain some enduring element of fame, some sol-
id and undecaying trunk with fruit-bearing branches, which
might have been overspread and hidden by a gorgeous
drapery of leaves and flowers, that enraptured the gazing
populace for a day, but had no charms for him. "When we
feel in our hearts this indifference to the fleeting, and this
warm regard for the permanent, let us believe that God has
implanted the instinct for a wise purpose; and then follow
it as a heavenly guide. It is manifestly intended to turn us
from the labors of the day — from the things which perish
when the hand which formed ceases to uphold them — to tile
things and objects which endure through indefinite ages —
renewing, I should rather say augmenting their magnitude
and their benificent fruits with every successive genera-
tion."

But we have no more room for further extracts. W©
would like to republish the whole of these discourses, as
they teach impressively the wisdom and humanity of medical
organization; and we hope and expect them to exert a hap-
py influence away beyond the locality of their delivery.

The pamphlet, we presume, can be obtained by address-
ing Moore & Anderson, 28 Fourth street, Cincinnati, O,

Medical Society of East Tennessee. 97

MEDICAL SOCIETY OF EAST TENNESSEE.

The Spring Session, 1852, of The Medical Society of
East Tennessee, will he held in Knoxville, commencing on
the third Thursday (20ih) of May.

Refinement, civilization, improvement, pn grcss, what are
they but the mutual action of man upon man: like marbles
in a mill, **e rub off rough corners by contact with anoth-
er. Neither is this the. only advantage of association and
fellowship. The old fable in iEsop has an application which
he did not deduce, but left us to discover for ourselves. The
bundle.of sticks when disunited, were not only more readily
broken, but in striking with each one separately, were used
and broken in vain,' without :iccompli.>hing anything: prop-
erly lied up they were a mighty weapon; and the more
closely they were bound together, the more impression they
could mak( — ihe more impossible it was to hreak them —
the mote invincible they became.

Even so, oh! Medical Society of East Tennessee, now
feeble and listless — would you gather strength, gather your-
selves together — thus would you cheer, comlort, encourage,
instru c. improve one another. As units, do you despond,
each seeing lit tie done bv his individual efforts for the cause
of Science a ltd Humanly: then resuscitate your sleeping
orgn /.i ion, and as we go hand in hand together, we shall
mute assist one another in our otherwise arduous and

irkst hie duties and lal ors. Tl eie has been no lull meeting
of oi body f r sometime; let us each try to bring his mite,
and i ibuTc his own presence to the session commencing

Onti third Thursday (20th) of May. D.

T ention of Druggists and Publishers is invited to the

cov he Record as an advertising medium.

98 Miscellaneous.

Medical Reading Room. — We have fitted up a room in
connection with our office buildings for the express purpose
of furnishing the physicians of East Tennessee, who visit
Knoxville, the pleasure of examining the various periodi-
cals received in exchange, and such new publications as
may be furnished us by the publishers. We, therefore, ex-
tend an invitation, and hope that physicians when in Knox-
ville, will consider this Medical Reading Room, as the ap-
propriate place to spend their moments of leisure. Of course
we desire the physicians residing in town to avail themselves
of this opportunity to examine the periodical literature of
the profession.

The Knoxville Primary Medical School went into ope-
ration on the ]6r.h of February, with one pupil. Several
applicants have been rejected because they did not possess
the acquirements designated as necessary before commenc-
ing the study of Medicine, by the American Medical Asso-
ciation. Others declined because not satisfied with the
terms.

Prop. Jackson, ot the University of Pennsylvania, propos-
es to have the American Medical Association composed
wholly of representatives from county%ocielies. The gen-
eral operation of the Association as at present organized,
Jjas exerted a happy influence; and we have an idea that
the influence might be made much more extensive if the
Association would take measures to extend a knowledge of
its action. Change, other than natural progressive growth,
is for the most part dangerous, and we hope that the pres-
ent organization will not be too suddenly, or without careful
deliberation interfered with.

Miscellaneous. 99

Medical Department of the University of Nashville. —
We are happy to hear of the almost unprecedented success
which has attended the effort to establish a Medical College
at the metropolis of our state. Home manufactories of
every kind should receive support, provided they use as good
material, and work it up as well as is done by others in the
same line of business elsewhere, and we therefore commend
to the consideration of Tennessee medical students, the
Medical Department of the Nashville University.

Exchanges. — As yet, but a few journals have honored the
Record with a place on their exchange list. This, we hope,
now that there is visible evidence of the Record's existence,
will no longer be the case. We thank the conductors of the
journals which we have received, for their promptness in
responding to our Prospectus; it is extending the hand of
fellowship in down-right earnest.

We return thanks to our friends for forwarding to the
"Record," DT. Fenner's very interesting address. It very
appropriately appears in the first number of a Medical Jour-
nal, issued in Dr. F's native state.

We hope that our next number will be the channel through
which at least one practitioner of each and every county of
East Tennessee, will communicate with their brethren
of the medical world. Unavoidable circumstances have
prevented our publisher from issuing this number at the
time stated in the Prospectus; and this delay will occasion

100 Miscellaneous.

a postponement in publication of the second number to the
month of August. Communications must be to hand on or
before the first of June.

We promise better typography in our future issues. The
Editor lacks familiarity with the position of proofreader,
which we have been, most unwillingly compelled to fill for
this number.

THE EAST TENNESSEE

RECORD OF MEDICINE AND SURGERY.

JULY 1852.— No. 2.
ORIGINAL COMMUNICATIONS.

Art. I. — History of the Medical Society of East Tennessee,

by Dr. Prank A. Ramsey, Cor, Sec., etc.

During the years 1843 and 1844, the spirit of improvement
and progress, in the medical profession of the United States,
seemed to be enlivened, and for its invigoration associations
began to be regarded as essential. Local societies were or-
ganised, and such ultimately was the force of sentiment on
the subject of combination, that the proposition to form a
great national medical congress, met with almost universal
approbation, and was speedily carried into effect. Moved
by the same spirit which was effecting so much in other
parts of the country — and which legitimately springs and
derives nourishment from a profound appreciation of respon-
sibilities involved, and clear apprehension of the necessity
of comparing observations to the attainment of correct ex-
perience — some of the practitioners of medicine, whose fields
of labor were in the then almost inaccessible country de-
signated as East Tennessee, attempted to arouse all the
medical men of the section to the formation of a District
Society.

102 History of the Medical Society of East Tennessee.

At length, after the appearance in newspapers of a num-
ber of articles bearing on the subject, and written by dif-
ferent individuals, and in accordance with a previously pub-
lished call, a number of medical practitioners met in con-
vention at Knoxville, on the 7th day of May, 1845; and af-
ter some preliminary consideration, they resolved themselves
into an organised body under the name of

The Medical Society of East Tennessee.
The convention was composed of twelve members, repre-
senting six only of the twenty-eight counties designed to be
embraced in the operations of the Society. But remem-
bering the fact that most large enterprises have a small be-
ginning, these twelve were not deterred by the fear of ulti-
mate failure from organising a body, which they hoped would
exert an influence commensurate with the objects intended
to be attained by such combinations of men engaged in the
same vocation. Two of these it was believed had been
longer engaged in practice in East Tennessee than others
residing in this division of the state; and they were appointed
to draft a Constitution and a code of By-Laws. These
were Sam'l B. Cunningham, M. D., of Washington county,
and J. G. M. Ramsey, M. D., of Knox county. Their report
was received and adopted, though they experienced much
difficulty in forming the article of the Constitution relating
to the qualifications necessary to membership. This diffi-
culty was occasioned by the prevalence of two facts: Many
reputable and energetic practitioners of medicine had never
graduated, — if indeed they had ever attended one course of
lectures — but who, nevertheless, manifested their sympathy
in the progressive spirit of the age, by anxiously endeavor-
ing to keep themselves familiar with the opinions of those
worthy of respect, the discoveries of the times and their ap-
plications, and with the observations presented through the
periodicals of the profession. And the more unfortunate
fact that there were some practitioners who "rested from
their labors," and presumed on the dignity conferred by di-

History of the Medical Society of East Tennessee. 103

ploma, and arrogated the supremacy expressed in connection
with their names on their parchment, but which they could
not gracefully, because not equitably, wear, however legit-
imate the consideration that the sheep-skin was their own.
The difficulty, however, was met, and the article, in connec-
tion with a resolution adopted at a subsequent meeting, and
explaining the operation of the article, yet governs the So-
ciety in its action on all applications for membership.

Art. 3. Any physician of good character and respecta-
ble medical attainments, known as such to the members
of the Society, on signing the Constitution and by pay-
ing one dollar annually, may become a senior member.
Any one wishing to become a junior member of the
Society, upon presenting a thesis on some medical sub-
ject, or being satisfactorily examined by a committee
appointed forthat purpose, and paying one dollar annu-
ally, shall be received as such. A list of whose names
shall be kept by the Recording Secretary. — Con. Spring
Ses., 1845. |

Resolved, That when an individual is proposed for senior
membership in this Society, the member proposing him
shall state in confidence all he knows respecting the
applicant's character and qualifications, and if these can
not be vouched for by some other member who is also
acquainted with the applicant, so as to be perfectly
satisfactory to the Society, the application shall be laid
over until the next meeting, and a committee appoint-
ed to inquire into the qualifications of the applicant.
Should he then receive two black balls he is rejected
as a senior, though he may be received as a junior mem-
ber by a vote of two-thirds; — and all elections for mem-
bership shall be by ballot, senior members alone voting.
— Spring Session, 1846.

Under this article, and operating in accordance with this
resolution, the Society has grown from twelve to^more than
seventy members, representing a little more than one half
of the counties composing East Tennessee. It can not be
told how many practising physicians reside in East Tennes-
see. At a session of the Society held in 1850, it was made
the duty of the Corresponding Secretary to attempt to de-

104 History of the Medical Society of East Tennessee.

cide this; and I accordingly addressed letters to the several
County Court Clerks, by whose kind agency I had hoped to
fulfill the desire of the Society. By the gentlemanly cour-
tesy of some of the clerks, I was enabled to form incomplete
tables, which are with the papers of the Society; — they
would be inserted here, if they were not so meagre — exhibi-
ting the state of the profession in less than half the counties;
and allusion is now made to them for the purpose of inducing
some one or more practitioners of each county to prepare
tables of their respective counties, that they may hereafter
be published complete and authentic. From the incomplete
tableslam enabled to state that of two hundred and oneprac-
ticioners who minister to a population of a little more than
one hundred and sixty-four thousand, or one practitioner to
every eight hundred and ten persons, thirty-five are gradu-
ates, forty-two have attended one course of lectures, ninety-
five profess to be "regular," but have never received instruc-
tion from any other source than reading, which for the most
part is limited, twenty-seven are botanic and steamers, and
generally most deplorably ignorant, and two are Homse-
pathies.

At the organization of the Society, the Code of Ethics
prepared by Dr. Cartwright for the Medical Society of Mis-
sissippi, was, with some modification, adopted. The force
of this code was afterwards destroyed by the adoption at
the fall session, 1847, of the very admirably prepared code
which had been sanctioned the previous May, and publish-
ed by the convention which terminated in the formation of
the American Medical Association. This code has been
placed by high British authority along side of PercivaPs
work, which until now has been the received standard, and
every practitioner and student recommended to add it to his
library. Such was the confidence of the Society in the gen-
eral correctness and explicitness of this code, that by reso-
lution at the spring session, 1849, the seyeral newspapers of
East Tennessee were requested to give it to their readers,

History of the Medical Society of East Tennessee. 105

in the belief that its general perusal would tend to produce
conformation in practice to its precepts, and thus essential-
ly aid in the attainment of the objects of the Society by
"advancing the morals of the profession."

This resolution was in keeping with the policy determin-
ed upon at the first meeting of the Society, and which con-
templated affecting practitioners by enlarging the public
comprehension in relation to medicine, and thus awakening
a demand for physicians who evidence care for their patients,
in an energetic and persevering attempt to advance them-
selves individually by zealously endeavoring to sustain the
worthiness of the profession. The sessions are semi-annually
held at such places as may, from session to session, be deter-
mined; and at such times a Popular Address is read by a
member previously appointed for the purpose. The addresses
are usually printed in pamphlet form, and freely distributed
amongst the people; and it is believed that until the Socie-
ty became lethargic good was thus effected. This feature
of the Medical Society of East Tennessee was presumed to
be peculiar, until the spring of 1849, when the Society's rep-
resentatives to the Amer. Med. Association learned that in
some degree it belonged also to the New York State Society.
That the objects designed to be attained by associations of
medical men must be fully and fairly stated to the general
public, few if any deny; but to what extent the intrinsic
duties of physicians should be explained to the public, is a
point on which great difference of opinion exists. This, it is
unnecessary to discuss here; but as to the propriety of widely
disseminating the resolutions of the American Medical As-
sociation, which embrace the relations of Medical men to
the public, and which have been adopted by the wisdom of
the profession thus assembled, and confirmed by resolutions
of approval by state, district, and county societies, and the
Code of Ethics which have been universally commended, it
is believed none will demur. For it seems to be an obvious
fact, demonstrated by the non-concurrence practically of

106 History of the Medical Society of East Tennessee.

medical men, and of chartered medical institutions, that the
recommendations of the association designed to advance
the educational standard of physicians, will never exert an
influence commensurate with the dignity of the recommend-
ing body, until the public is made acquainted with the na-
ture of the resolutions, familiarised with the circumstances
which originated them, and made to apprehend forcibly the
necessity of an operative influence being exerted by them.
The public will thus be made an active agent in the attain-
ment of the objects so much desired by those who best ap-
preciate the wants of the profession. The Medical Society
of East Tennessee felt the force of the plans adopted by in-
dividual empirics and followers of systems in medicine, and
did not conceive that an error would be committed in adopt-
ing a line of policy which promised to arouse the people by
giving them information on subjects which so vitally affect-
ed them, thus exposing the shallowness of pretence which
so frequently is sustained merely because it makes its appeal
to the public. The Medical Society of New York was
moved by the same considerations, and there as here, the
policy is believed to have effected good. If so, does it not
merit a trial by the great association of the profession? and
is it not probable that such a trial would result in conform-
ing medical men and medical colleges to opinions which
have thus far met with almost universal approval?

The organization of the Medical Society of East Tennes-
see, acted as a stimulant to some physicians who had long
been engaged in practice in fields which had furnished them
abundantly with material with which to interest and in-
struct senior as well as younger practitioners. This mate-
rial has in some measure been worked up, and presented to
the profession through the pages of the Augusta, Nashville
and Charleston Journals — mostly the latter. These papers
have met with a reception which their intrinsic merits de-
manded from the profession, and have elicited complimen-
tary notices from the editors of journals, and private com-

History of the Medical Society of East Tennessee. 107

mendatory letters to the authors from distinguished medical
men abroad. And in this connection it will not be consid-
ered inviduous to specify the two papers by Dr. J. P. Evans,
embodying observations and the reflections to which they
gave rise, occurring to him during his service as Surgeon in
Mexico, on diseases which universally demand attention
from medical men. These have been referred to by con-
tributors to medical journals in our own country, and their
practical features have not been permitted to pass unnoticed
by the winnowing laborers of Europe. The favorable im-
pression which has thus been made by the published pa-
pers of the Society is not referred to here for the purpose of
adulation, but for one more glorious, that of exciting mem-
bers of the Society to persevere in attempting to preserve
their organisation, and of instigating others, to make a com-
mencement, who as yet have made no effort to comply with
the rule of Sydenham, "virtuously and honestly to arm
others with such safe-guards as we have ourselves learned."
The records of the Society do not furnish me with means
sufficient to refer to any considerable extent to the charac-
ter of surgical skill in East Tennessee. The statement which
is below,was furnished 2 years ago at my request, by Dr.S.B.
Cunningham, our first President, to whom I wrote, because
I regarded him as having operated more extensively than
any other practitioner within our district. But he is not the
only operator. I have already in another connection refer-
red to a gentleman who has successfully wielded the instru-
ments of surgery both in private practice and as an officer
in our country's army; and there are others of less extensive
experience, but who promise to become known as expert
operators. But before proceeding to the table which I have
formed from Dr. Cunningham's communication, it would be
amiss not to refer to Dr. W. H. Deaderick, the pioneer of the
surgery of East Tennessee, who devised and first success-
fully performed the operation of amputating the lower jaw;
an operation which great men have claimed as their own,

108 History of the Medical Society of East Tennessee.

and been compelled to retract; men greater than those now
attempting to gain eclat by performing it, and publishing the
cases with references to surgeons of England and France who
first performed it, without any notice of its origin in the
Switzerland of America. His name is impressed on the
annals of surgery, and is inseparable from the designative
of his nativity, his growth, and his maturity — East Tennes-
see. We are happy to say in this running record, that Dr.
Deaderick yet lives, residing at Athens, the county seat of
McMinn county, and at his pleasure engages in professional
labor.

In a country with a population so sparse as this, very
many operations can not be required; and when it is remem-
bered that different points of this section of the state are
more contiguous to the larger cities of this and other states
than to Jonesboro', it will present a reason for the seeming
meagreness of operative surgery in East Tennessee.

In his letter Dr. Cunningham says, "I have taken some
pains to cull out those that occur to me as important opera-
tions in a surgical point of view, leaving out dislocations,
fractures, most mid-wifery cases, many of which are, in a
practical view, as important as operative surgery itself.
Very many small operations of common surgery which oc-
cur in almost every physician's practice, I have omitted, and
I may have overlooked some of the more important. Many
of the cases are possessed of great interest in detail, if I
had now the time to write them out;— but hereafter, if
deemed necessary, I will, at my leisure, write out any of the
cases which may be designated. Heretofore I have been

so disappointed and misled by journal reports myself, when
the object has been more to make out the case for public
display than to give plain facts, that I have withheld, when
perhaps I might have added something to the profession.

"I presume that I have been about twenty-eight years in
practice. For the first eight or ten I operated but little; —
most of my cases are within the last fifteen, and those of the
largest grade within the last ten years."

History of the Medical Society of East Tennessee. 109

No.of

Unsuc-

Complete

Partial

times

cessful.

recovery.

benefit.

Death p.

* 6

Arm, Amputations of,

Shoulder Joint,

Fore-arms,

Femoral,

Total removal of female breast,

Strangulated Hernia, ,

Festula in Ano,

Bronehotomy,

Hydrocele,

Trepaning,

Lithotomy,

Exsection of Eye,

Couched,

Anurism of Brachial Artery,

Necrosis and Sequestra,

Sarcocele ) _ . . _, .

Hydated \ Removal of Testes,

Tumors,

Polypus,

Club-foot,

Paracent Abdominalis,

Removal of Paroted Gland,

Cesarian operation,

Embryulcia, %

Ruptred Uterus,

Femoral. — Operation in fatal cases after mortification had commenced.

Total removal of female breast. — Fatal in a short time.

Strangulated Hernia. — Fatal soon afterwards. Some of these cases were
highly important in facts.

Trepaning. — Those partially benefitted would no doubt have recovered,
but for after mismanagement.

Lithotomy. — First case followed by vcsico-rectal fistula — the patient lived
two years, and died with tetanus.

Couched. — One not heard from.

Necrosis and Sequestra. — Some bones removed & inches long, others 6, and
some smaller size. Two of these cases involved the thigh bones, the others
the arms and tibia; all required extended and sometimes deep cutting.

Sarcocele. — The Sarcocele weighed 2 pounds 10 oz.

Tumors. — 1 case, child, six months. Involving the whole cheek from the
angle of the mouth backward, encroaching on the mouth, as large as the child's
head. 1 case, under deep seated facia of the neck, under the angle of the jaw,
in contact with the internal jugular and caroted artery. Internal jugular
cut and tied. 1 case submental and sub-maxallary very difficult.

Polypus. — 1 Polypus weighed over a pound; all large.

Removal of Paroted Gland. — I am aware of the discussion had on this
point, but I know and can prove what I say. It was altogether the most per-
ilous operation to the practitioner I ever performed. Its history is interesting.

Cesarian operation. — Operatcd^onthc day of labor. Patient exhausted; of
strumous habit; had suffered in childhood from diseased bones, white-swel-
ling, &c. Died of general pcritonites and exhaustion on the 3rd day.

Embryulcia. — Never operated in my own practice of obstetrics; but have

110 Dr. Barr's Address.

had other kinds of instrumental labor, without dissection. In two cases of
convulsions used the crotchet and forceps.

Ruptured Uterus. — Child escaped among the bowels; child grasped by the
feet, brought back through the uterus, and delivered. Clots removed by
hand from the bowels. Death from Peritorial inflammation.

To this table might be added a variety of minor and of ac-
cidental operations, or operations demanding, from the na-
ture of the circumstances, immediate performance, — and
which of course occur in the practice of almost every med-
ical man. But it is not deemed necessary. The table we
think will at least shew that surgical expertness may be
gained, and success attend the practice in country locations
as well as in the larger cities.

The records of the Society would furnish me with various
other items, which would probably prove of some interest;
but it is hoped that enough has been culled to exert the in-
fluence which is so much desired, and that it will be shown
in the largeness of numbers of members in attendance, and
the variety and extent of communications, at the next ses-
sion of the Medical Society of East Tennessee, which will
be held in Knoxville on the third Thursday of October next.

The first Popular Address was read by Dr. W. F. Barr, then
of Greenville, but at present successfully engaged in the discharge
of professional duties in Abingdon, Virginia. This address, with
other papers which have been, from time to time, presented to the
Society, but which have remained in the possession of the Cor*
Sec, it is believed should be placed before the profession.

April 30, 1852.

Art. II. — Popular Address by Dr. W. F. Barr, of Greenville,

Tennessee.

When the universe came forth from the plastic hand of
the all-wise and omnipotent Creator, certain laws were giv-
en to the animal, vegetable and mineral kingdoms. But
mutability is indelibly stamped upon everything embraced
in these three kingdoms. Nations after nations have aris-
en ; they have sailed triumphantly upon the sea of fame and

Dr. Barr's Address. Ill

renown ; their names, with those ot their great and good,
have been heard in distant lands; their institutions have
been considered the best for the liberty, peace and interests
of man. But where are they now? "They were, but are
not." Their greatness has been changed into ignominy, and
they are now slumbering in the ashes of their pristine glory !

Where are the many famed institutions of learning of
ancient times ? They, too are gone ! "The experience of
five thousand years attests the melancholy truth that man
and all his institutions are subject to mutability and disso-
lution." . . . "The systems of the ancient philosophers, their
religious rites and institutions have shared alike in the gene-
ral wreck." Those of Pythagoras, Epicurus, Socrates, Pla-
to, Aristotle, have passed away, and truth, though it had
long been crushed to earth, has taken their place. All
things, animate or inanimate, organic or inorganic, are
alike subject to these laws.

Notwithstanding this be true, yet the laws by which all
things are governed remain, and have remained, the same
since the time they were given by the Law-giver of the uni-
verse.

We have seen the doctrines of Philosophers of one gene-
ration recede for those of another. But shall this change in
opinion be brought up as evidence that the laws of nature
have undergone a change? Because some Chemists have
asserted that fire, air, earth and water are elements, and
those of our day deny it, having proved that they are com-
pounds, shall it be said there are no elements? Because the
Alchymists held many false notions, shall we say there are
no truths in Chemistry ? Shall we, because many Natural-
ists have advanced opinions greatly differing from each oth-
er, assert that there are no truths in Philosophy ? From the
system of Astrology arose the grand, sublime and interest-
ing science of Astronomy. Shall we, on this account disbe-
lieve the science ? We have Astronomers differing in
opinion upon the solar system. We find Ptolemy at one
period contending that the earth was stationary, and that

112 Dr. Barr's Address.

the sun and the different planets revolved around it, — and
advocating his system of epicycles and deferents. Alphon-
so X. arises and ridicules his opinions, which appeared so
absurd to him, that he remarked of them, "were the universe
thus constructed, if the Diety had called me to his councils
at the creation of the world, I could have given him good
advice." Copernicus arises and asserts that the sun is sta-
tionary, and the planets move around him. Then arises
Tycho Brake denying this, and contending that the earth
was immoveable, &c. Kelper and Galileo succeeded, and
advocate the Copernican theory,— some maintaining that the
planets have circular orbits, others that they are eliptical]
Shall this contention among different Astronomers in differ-
ent ages, cause us to deny both theories, and assert that
neither the sun nor the earth revolve, and consequently
have no orbits !

If Franklin explained electrical phenomena on the prin-
ciples of positive and negative electricity, and Du Fay on
that of attraction of two kinds, resinous and vitreous elec-
tricity, shall we assert that there is no cause for these phe-
nomena ? Who will be fool-hardy enough to contend that
because there has been a great contrariety of opinions as to
the origin of man, (some having asserted that he was origi-
nally]an oyster, others a vegetable, and others a monkey) that
man was not formed !

Divines of different ages have advanced a diversity of
opinions upon the Bible,— is this a just cause, or good rea-
son, for denying the Bible, or that it contains any doctrines ?

If then, the differences of opinions as advanced in Chem-
istry, Philosophy, Astronomy, Theology, &c, is not to be
attributed to these sciences themselves, nor to any change
which may have heen wrought in their laws, to what then,
must we attribute it ? To the judgment of man. Man, in
his judgments and opinions, as in every other respect,
is "as prone to err as the sparks are to fly upward." Hu-
manum est err are. Therefore, to this cause, we may justly
attribute all those changes in the opinions of different ages

Dr. Burr's Address. 113

which may have been wrought in the different sciences, and
not to the laws by which they are governed.

Many, it is true, are ever ready to deny every opinion
which may be advanced, because its votaries may entertain
and advance different views and hypotheses. They deny the
truth of a science because there exists different opinions in
relation to its laws, and the effects of those laws. Such rea-
soning, or sceptical notions, a moment's reflection will set
at nought. From such a process of ratiocination, has arisen
the opinion, which, it must be acknowledged, is very pre-
valent, that Medicine is not a science, but a well regulated
system of guessing. From such an opinion we beg leave to
dissent; and maintain that Medicine is a science.

The science of Medicine in its first periods was almost bu-
ried in superstition. Resorts for healing the sick, were had
to amulets, talismans, witchcraft, &c. And the remarks of
Lord Bacon are true, "that in the opinion of the ignorant
multitude, witches and imposters, have always held a com-
petition with Physicians." This we find true, not only in the
early stages of society, but even in the present age ! And
when we reflect that Medicine was but little understood,
and but few articles in the Materia Medica known, it is not
at all astonishing that a resort should be had to any and
every plan for the purpose of healing the sick. And all
these plans, simple and foolish as they now seem to us, have
led to the discovery of the medicinal virtues of many articles
now used.

Among the ancients it was customary, when a person
was wounded with an instrument, to dress the weapon for
several days, for the purpose of curing the wound ! Dryden,
in his "Enchanted Island," speaks of the superstition.
Ariel — Anoint the sivord which pierced him with this
Weapon salve, and wrap it close from air
5 Til I have time to visit it again."

Sir Walter Scott also speaks of this in the "Lay of the
last Minstrel."

"But she has ta'en the broken lance,
And washed it from the clotted gore,

114 Dr. Ban's Address.

And salved the splinter o'er and o'er.
William of Deloraine, in trance,

Whene'er she turned it round and round,
Twisted as if she galled the wound.
Then to the maiden she did say

That he would be whole man and sound."
Charming, also was resorted to for curing diseases. Al-
lusions are made to this superstition by some of the Poets :
"Tom Pots was but a serving man,

But yet he was doctor good;
He bound the 'kerchief on the wound
And with kind words he staunched the blood."
In the Lay of the Last Minstrel, Sir Walter Scott says :
"She drew the sdinter from the wound
And with a charm she staunched the blood."
Sennertus says that the older surgeons had recourse to
magic and prayers for the purpose of extracting foreign bod-
ies from wounds. Celsus recommended a portion of human
or horse flesh, or the warm blood of a recently slain gladia-
tor for the cure of Epilepsy. Metalic and wooden Tractors
also had their day in the performance of wonderful cures.
Thus ever since the formation of society, we find a strong
disposition in man to administer to the wants of the afflicted
and if possible to heal the sick. In the efforts to do so, one
medicine after another has been discovered, and its appli-
cation to diseases ascertained. We, at a glance, see that
Medicine has arisen from the indefatigable efforts of men in
every age, until she now occupies a stand among her sister
sciences! What if false and ridiculous notions have been
entertained, — shall that cause us now to disbelieve in the
science? What if various opinions are now entertained in
the Profession, upon medicines and their modus operandi —
of the pathology and cure of diseases? Shall we, on this
account deny the science ? These differences are to be at-
tributed to no other cause than errors in the judgment of
men. If these differences of opinion are to destroy the sci-
ence of medicine, every other science must totter and fall —
and with them, the lovely, pure and holy system of the reli-
gion of Jesus Christ ! #

Dr. Barr's Address. 1 1 5

It must be acknowleded that the unbelief in the science
of medicine is, in a great degree, to be attributed to practi-
tioners themselves. It is a sad and lamentable fact, that in
most places, the intercourse between the different members
of the profession has not been such as should exist among
those who are engaged in the healing art. Too many have
forgotten the noble and philanthropic purpose of the profes-
sion ; and entirely under the influence of self-aggrandise-
ment while endeavoring to promote their own personal in-
terest, have given a stab to this time-honored science ; and
thus have done their part in bringing upon it all the con-
tumely and discredit under which it may now be laboring.
In the house of its friends it has been stabbed to the vitals.

We are told by those who disbelieve in the science, that
Physcians themselves, while treating the same disease, will
treat it differently. This is not as true as it appears to be.
This difference may be attributed to the difference in the
stages of the disease ; and also to a difference in the judg-
ment of Physicians. For it is a fact that can not be doubt-
ed, that there is but little difference among Physicians in
treating diseases. The objectors are not aware that there
are many medicines possesing nearly the same properties.
They know there is Opium and Morphine, but little do they
know that both these medicines have the same properties.
In the treatment of a case, the attending Physician may be
using Opium ; another be called in for consultation, who
thinks that Morphine would be preferable, or perhaps any
other article in the long list of narcotics. The Morphine
may have a more desired effect than the Opium, in sub-
stance — the patient recovers. The consulting practitioner
tells wherever he goes that it was by his prescription that
the patient recovered. Then it is heralded "over hill and
dale," and the opinion excited that there is a difference with
the two in treating diseases — that medicines possessing dif-
ferent properties are used by different physicians in /the
treatment of the same disease. Thus it is in hundreds and
thousands of instances. How often are we told by those

116 Dr. Barr's Address.

that wish to disprove the science, that in the treatment of
Intermittent Fever, one physician uses Peruvian Bark, an-
other Quinine, and another Chinconine !

But a better day is dawning. The people are being
awakened to consideration, and the more honorable in the
profession are depriving the charlatan of his "catholicon,"
and are by laudable example and exertions endeavoring to
elevate it to that standard to which it is so justly entitled.

Among the many plans which are being used for the pur-
pose of diffusing medical knowledge and elevating the pro-
fession, we are happy to mention the "Medical Society of
East Tennessee." Empiricism exists in every land and
country, but it must be acknowledged that it is as prevalent
in East Tennessee as elsewhere. The name of "Doctor" is
so enchanting and appears to have such a pleasant sound
upon the ears of many, that, although without the rudiments
of an English education, they will engage in the study of
medicine. There are many Physicians who have no more re-
spect for the profession than to receive all such applicants.
Such young men have never reflected upon the character of
the profession — they have never considered its objects — con-
sequently they are ignorant of all its purposes, but that of
making "filthy lucre." A few short months is enough for
them to study, and then without either a common educa-
tion, or a knowledge of medicine, they engage in practice
with all the brazen impudence which characterizes an ig-
norant pretender ! Without hopes of success on honorable
principles, they, like their great father and leader, Paracel-
sus, are compelled to resort to low, cunning and dishonora-
'ble knavery. That "a little learning is a dangerous thing,"
is fully verified in their cases. They only know enough to
think themselves wise, and not enough, to find out what Soc-
rates did, that they are ignorant. With a lithe egotism of Par-
acelsus,who declared that the "very down of his bald pate
had more knowledge than all their writers — the buckles of
his shoes more learning than Galen and Aricanna, and his
beard more experience than all their universities," — they

Dr. Ban's Address. 1 1 7

embark upon practice ; and like him. to advance themselves,
they will defame the characters of learned and success-
ful Physicians — they will mount to prosperity upon the
pyre of the wreck they have made of the honor and success
of learned and worthy ones, thus elevating themselves by
destroying others. They will engage in a cunning, under-
mining, electioneering scheme, and even go so far as to visit
another's patient, speak of his manner of treating diseases,
and use every effort which unblushing impudence and ig-
norance can devise, to secure the dismissal of the attending
Physician.

The most superficial observer can foretell what will be
the result if some measures are not taken to suppress such a
system, or the people do not arise in their majesty and dis-
countenance it. Learned and successful practitioners will
be driven from the profession ; and young men of education
and talents will not engage in it — believing, as they must,
that, after spending years of time and their money, that they
can be supplanted by a simpleton, who has studied but six
or twelve months.

Why it is that the people do not pay more regard to the
qualifications of a Physician, is difficult to divine. A
Preacher or a Lawyer must be learned. Perishable proper-
ty can not be confided into the hands of an ignorant Law-
yer! No ! they must be learned, for it is required by law,
that they shall undergo a strict examination by the Judges
of the Court before they are permitted to engage in the prac-
tice of their profession. Yes, a man must be prepared and
well qualified before he can engage in the practice of law !
But alas ! when the fell hand of disease seizes upon the
body, — the frame is racked with pain, and human nature
sinks almost powerless and pulseless under its effects, any
body will do for a "doctor." So he has the title, that is suf-
ficient.

To remedy these evils, it entered into the minds of a few
of the noble-souled and patriotic members of the profession,
to form this Society. They were foiled in their first effort;

118 Dr. Barr's Address.

but with undaunted spirit — feeling the good of the cause
which they had espoused — they persevered until they ac-
complished their object. He who proposed this measure,
and those who so nobly contended for it, deserve the thanks
of their brethren.

The objects of such a Society are known and it may seem
unnecessary for me to repeat them; but as many are inclin-
ed to oppose them, as they do every thing else that is good,
in order to silence their misrepresentations, I will assert
them.

They are the diffusion of medical knowledge, and the pro-
motion of that peace and harmony which should always ex-
ist among members of the same profession. The utility of
such a Society is well known to ail the reflecting. It has
been well remarked that, "nothing exerts a more salutary
influence over the profession than well-organised Medical
Societies; — they not only elevate professional character by
extending the knowledge of each member, but they are also
most efficient aids in allaying personal differences, and har-
monising the views and feelings of all, who are thus brought
in contact."

Paris, London and other cities renowned for their medi-
cal and surgical attainments, owe a greater part of their re-
nown to their Societies. In such Societies subjects are pro-
posed, these are read and their doctrines discussed. Thus,
when Physicians are brought in contact, there is an "inter-
change of thought" upon theory and practice which, of
course, must result in good to all, and every member can
truly say, "it was good to be there."

As there is no law in this state, in relation to those who
engage in the practice of Medicine, this Society accomplish-
es another object, viz : examining into the qualifications of
young men who wish to engage in the practice. There are
many talented, well-educated and enterprising young men,
who are unable to attend a Medical College and procure a
Diploma. As the laws of this state do not require a Diplo-
ma from a Medical College, this Society proposes, in order to

Cunningham on Diseased Kidney. 119

protect the people from a pretender, as well as a recommen-
dation to the young man, to examine all such, and if found '
worthy, to give them a certificate of their qualifications. .
There is no law, as before said, to compel any one to under-
go the examination, but the advantages resulting from this
plan of the Society, will, at once, be seen to be great, — it will
be a safeguard to the people and a recommendation to the
young man. The necessity of rules of etiquette by which
the members are to be governed, is apparent to all.

Gentlemen of the Society, we are engaged in a good
and a noble cause ! Let us use our efforts to promote the
interests of our profession, that after having performed the
cycle of our duties, when summoned to appear before the tri-
bunal of the great Physician above, we may receive the wel-
come plaudit of "well done, thou good and faithful servants."

Art. III. — Case of Diseased Kidney \ with Post Mortem, by
Dr. Sam'l B. Cunningham, Jonesbord*.

The following case which I shall present to the Society,
if not full of practical results, is interesting — highly so in
its pathology, and from its results instructive and calculated
to direct attention to an obscure morbid action in organs we
fear are too much neglected or overlooked by the profession.
If it should have the effect of turning the timely attention
of any practitioner to such diseases in future, we will have
gained one object in reporting it. Surely, none who were
present witnessing the case and its autopsy will ever for-
get it.

George Brunner, aged 50, was of. a strumous habit, as indi-
cated by his light gray eyes, fair thin skin, coursed by super-
ficial veins, with intelligent countenance, quick sensibility,
and with considerable irratibility of temper. Together with
these, he had suffered as we are informed, with a most pain-
ful and protracted white swelling of the upper portion of the
os femoris, which broke at two several periods, occasioning
great suffering. Bones were discharged at each period

120 Cunningham on Diseased Kidney.

after which it healed; leaving him a shortened limb from
contraction, and occasional hurting during life. After this
healed he was long afflicted with a distressing head ache,
which at times was almost constant. This was in character
with the sick head ache, as it is commonly called. At some
early period after the thigh healed he felt symptoms of dysu-
ry assimilating gravel; which symptoms also attended him
the balance of his days. He had micturition stillicidium,
bloody urine, sometimes mixed with puruloid discharge; and
which, when we saw him, was voided after or with the last
discharge of urine. These symptoms were paroxysmal in
character, just as in gravel. No examination, so far as we
learned, had ever been made, either upon the urine and its
deposites, or by sounding the bladder. He had suffered from
occasional pain in the lumbar region and with piles, which
had been exsected. He was corpulent and sanguineous in
appearance until the fall of '46. Having engaged in stock
driving during the last season, the risk of loss and other
perplexing matters during the trip, taxed his energies and
activity of mind to the utmost. Loss of rest and a southern
climate may have had their full share in operating upon
an uncommonly excitable frame. So it was that he took on
gastric disease, attended with biliary derangement. On
his return home his skin was considerably tinged with yel-
low, as were the tunica albuginea, attended with great gas-
tric disturbance. Appetite precarious, acid vomiting or eruc-
tation was almost constant after food; but the bead ache dis-
appeared and he felt it no more. One other symptom of
importance I should not omit, namely: a copious diuresis,
wfyich he had frequently observed at times before, now be-
came a subject of serious'attention, leading to the appre-
hension of Diabetes. A Thompsonian being consulted, put
him under their preposterous appliances, only to exasperate
the case. A worthy friend and respectable physician, Dr.
Rhoton, together with Dr. Reese, were next consulted;
from which period we have a more accurate account of
the case. Dr. Rhoton found his urine greatly increased in

Cunningham on Diseased Kidney. 121

quantity, and as he thought, attended with the peculiar
smell resembling broth or ha} T , according to Prout, I believe,
or an apple room, according to the sense of Prof. Watson,
but no chemical tests were used. The vomiting was fre-
quent; he ejected almost every thing in about an hour after
eating it. The matter ejected was mixed with yeast as a
test, according to the recommendation of Dr. Watson, to see
whether a fermentation would ensue, which the author con-
siders distinctive of Diabetes. It did ensue, and he was re-
quested to taste the urine, which he thought had a sweetish
taste. Considerable thirst attended, but no particular crav-
ing for sweet articles of food or drink, as is usually the case
in Diabetes. Some fullness existed rather in his sides, and
on hard pressure over the epigastric region. Pulse some-
what excited and corded, beating, as is supposed, from eighty
to one hundred per minute, and as Dr. Reese informed me,
"very peculiar in character, attended rather with a jerking
sensation," never soft and natural, and according to the im-
pression of both gentlemen judging it a priori without the
aid of other symptoms, would have prompted the use of the
lancet. This, however, was not judged best. The tongue
was covered with white fur to the tip at first, and with a
heavy brown further back, towards the last. No cough nor
indication of cerebral lesion till very late in the disease. The
skin was usually dry, but easily altered by Dover's powders
and ipecac. Purgatives of Rhei and oil were used to open
the bowels and carry off their contents; bathing, antacids,
&C, were all employed; a regulated diet of hard biscuit and
soft boiled eggs were ordered as food. The antispasmodic
of ammonia, laudanum and blisters were applied to the
stomach to allay irritation. His drink was slippery elm or
infusion, and in but limited quantity. The apprehension of
Diabetes deterred from the use of calomel, lest it should pro-
duce increased diuresis, which had now somewhat subsi-
ded. The yellow color of the skin continued, dark sordes
were discharged from the bowels when moved ; a cos-
tive habit previously attended, according to the patient's

122 Cunningham on Diseased Kidney. ,

own account of it, with clayish colored passages, which
determined the use of calomel, hitherto avoided for fear of
determining to the kidney. Four or rive grains of calomel
with six or eight of Dover's powders were now administered
morning and evening for several days, and its operation on the
bowels, being enforced by oil and clysters, copious dark bil-
ious dejections came off as the result. The tongue partially
cleaned and the patient was thought to have improved, but
after two or three days this treatment was again suspended,
lest the constitutional effects of the medicine might exercise
an undue influence on the kidney,and precipitate a Diabetes.
Opium and ipecac were, however, continued occasionally
afterwards. The opiate, in whatever form administered,
always tranquilised the symptoms and soothed his mind to
sleep. On the 24th of February, a spasmodic twitching
took place in the shoulder of the left side, (the same side as
that in which the white swelling had occurred.) At first it
excited but little attention; but a rapid increase of the symp-
tom and extension to the whole limb, proved it to be of a
more formidable character. The whole side, diaphragm
and muscles of respiration, and finally those of the opposite
side, suffered an almost constant subsulta. The abdominal
parts twitched constantly; the tout ensemble wore the char-
acter of a very bad case of St. Vitus' Dance, with paroxys-
mal exacerbations, threatening instant dissolution. On my
arrival he was in, or rather recovering from, one of those
paroxysms. A consultation was immediately held in a free
and cordial manner, after a full examination of all the symp-
toms. The spine, I should have mentioned, betrayed no
particular tenderness from the occiput to the sacrum, but
there was tenderness in the region of the kidneys, and also
over the epigastrium. The patient was sensible, though I
thought, volatile in feelings, attended with nothing like stupor;
on the contrary, there was an exuberant activity of mind; the
eyes yellow but expressive. He had passed but little urine
to-day, with one copious dejection from the bowels and very
offensive; pulse about 100 or upwards, quick and a little

Cunningham on Diseased Kidney. 123

tense, but compressible. Before concluding the consulta-
tion, we were summoned speedily to our patient, whom we
found entering into epileptiform convulsion, lasting some
minutes. When it wore off he fell into sleep and recov-
ered in about an hour to full consciousness of the present^
but with no knowledge of what had passed in his convul-
sion. He had a second some hours after the first, running
through the stadia like the first. His pulse, depressed in the
paroxysm, regained its former action; the abnormal muscu-
lar action continuing in the intervals of convulsions, or rather
increasing in violence. Twenty grs. calomel was concluded
on to act freely on the bowels and rouse the activity of the
liver, to be followed by clysters; the back of the neck was
blistered freely; sinapism washes to the feet and legs, and
about half a grain of opium with an equal quantity of ipe-
cac, to quiet the irritability. This had the desired effect.
We also gave ten or fifteen grains of assafoetida through
the night, or its tincture, for the same object. In the ensu-
ing morning an injection of a pint of salt water was thrown
up the rectum which procured a copious black discharge,
but without urine. As he had passed none for near twenty-
four hours preceding this time, we introduced a catheter and
drew off over a pint of healthy looking urine, except at the
last there were a few drops of purulent looking fluid, which
readily mixed or sank into the urine. From these discharges
the patient experienced much relief. His spine was again ex-
amined and a large blister applied over the lumbar region,
extending up the spine to the shoulder. The blister run
well, and he took a little tea and bread; spasmodic action not
changed, and rather more debility; pulse 106, of good
strength. Musk was administered to-day in 8 gr. doses
every two or three hours until about 2 o'clock, P. M., when
the general convulsions returned, and continued with short
intermissions through the night, always commencing like a
regular aura epeliptica in the weak leg or thigh, so long as
he could speak, attended with the most excruciating pain,
passing up the limb and side, and ending in a moment with

124 Cunningham on Diseased Kidney.

general convulsion. He had about twenty-eight or thirty
paroxysms through the night, and expired about six o'clock

next morning.

Leave was granted by the family, and an autopsy com-
menced at 9 in the morning, about three hours after death.
On opening the abdomen, we found the omentum quite vas-
cular with yellow tinge; transverse arch of the colen disten-
ded and much injected with patches of livid appearance ;
mesenteric attachment much inflamed; duodenum and duc-
tus communis also inflamed; the liver thickened and hard, and
dark at the lower edge of both lobes, the body and common
surface looking healthy and not enlarged; the gall bladder
distended with dark bile; the stomach exhibited no visible
traces of disease, unless it was on the convexity, where the
omentum minor was attacked; right and left colon and ileum
healthy; an interesting intussusceptio was found in the
jejunum about one third of its length down, swollen and vas-
cular but without adhesion, closing up the bowels and re-
taining all the contents of the upper portions with which
they were considerably distended; the urinary bladder was
much thickened and ulcerated in specks over the mucous
membrane, but no appearance of calculi or sandy matter;
the ureters not examined, but think there can be little doubt
were in a similar condition; the left kidney enlarged, irreg-
ular, with watery vesicles on the surface; cortical part ir-
regularly hard and infiltrated; on laying it open the tubuli
and infundibuli appeared healthy in structure, as did the
pelvis of the organ; the right kidney presented the outlines
of an enlarged organ, irregular as the first, distended with
a* semicarious substance filling up the place of the entire
body of the organ, which, when opened, presented the ap-
pearance, as was well observed by Dr. R., of the inside of a
ripe papaw more nearly than anything with which I can
compare it; it required considerable washing to cleanse it;
the membrane or covering exhibiting nothing like the struc-
ture of the gland, but as you will perceive, (for I have the
pleasure, through the indulgence of the friends, to nr?«*?nt

Fleming on Uterine Hydatids. 125

it here before the Society,) the cortical part is much atten-
uated. In the healthy state authors say it is several lines
thick; it is as you see not more than half a line. The tubu-
lar portion is entirely gone; the infundibuli are also destroy-
ed; septae are visible, perhaps marking cysts of the matter
which as I said was washed off. I have luckily found one
cyst which escaped the knife, and which we will now open,
containing the same brainy like substance with the rest.
The inside of the whole is lined with a fleecy coating like
the inside of a beef's maw. The ureter, as we now find on
examination, is impervious. This is not a laudable pus,
such as presents in ordinary suppuration, but appears to
have been more probably the result cf ramollissement of
the organ, ending in total disorganization. It would seem
to be intimately associated with his strumous habit, the
disease having attacked this organ.

Art. IV. — Uterine Hydatids.read by R. N. Fleming.

July 2d, 1849, was called to visit Mrs. K., aged about
fifteen, one of triplets, and about twelve months married;
thought to be in labor, and suffering from pain and uterine
hemorrhage.

She had considered herself pregnant and had suffered
much at times for some months past; the more prominent
symptoms latterly having been haematemesis and uterine
hemorrhage accompanied with pain. She had suffered much
for twenty-four hours past, from pain and hemorrhage, hav-
ing discharged large quantities of both fluid and coagulated
blood; and, about 12 o'clock at night, and before my arrival,
the uterus had relieved itself of two masses. She had ex-
perienced much relief after the expulsion of the masses.

On- examination, the smaller mass was about 8 inches
long, narrow, ragged and torn, fleshy on one side, much re-
sembling the uterine surface of a placenta. To its other
side it had attached some shreds of membrane and several
cysts of the size of large marbles, containing a straw-color-
ed fluid. The larger mass was not more than six inches
i)

126 Carriger on Spasm of the Epiglottis.

long, but much broader than the other; of the same fleshy
appearance on one side, and on the other had a sort of mem-
brane studded with an innumerable quantity of cysts, vary-
ing in size from those of the other mass to that of a pin's
head, and containing the same kind of fluid.

Thinking that a foetus might be found in the masses or
among the coagula that accompanied them, I examined
them carefully and minutely, but could find no trace of
either a fostus or an umbilical cord. These masses did not
present the vascular appearance that a placenta does.

Was this a case of the degeneration of the product of con-
ception by hydatids merely, or did these masses and hydatids
originate and exist as a production unconnected with con-
ception?

Art. V. — Spasm of the Epiglottis, communicated by Dr. J.

H. Carriger, Tazewell, Tennessee.

On the evening of the 24th March, 1848, I was called to
see a mulatto girl, belonging to Maj. Gideon Brooks.

At about ] o'clock, A. M., while attending to her work
as usual, she suddenly dropped down on the floor apparently
dead. For five or ten minutes there was no apparent breath-
ing, and after the lapse of this time, so slight and so partial
was her respiration that it could only be perceived on a very
close examination. She lay entirely unconscious; her mus-
cular system entirely relaxed; pulse feeble; eyes closed. ■
She remained in this condition until 2, P. M., when she open-
ed her eyes, looked about wildly and attempted to speak, but
could not. Some water was now offered her but she could
not swallow. Presently her breathing became noisy and
continued so for about half an hour, when it appeared to
cease entirely, but in a few moments it was re-established.
It was now more noisy than before for some time, and then
grew nearly natural, and continued so for a considerable
time, when it was again interrupted and again restored, yet
with increased noise.

Carriger on Spasm of the Epiglottis. 127

From 2, P.M., until 6 these paroxysms had been gradually
yet rapidly increasing in frequency and severity. From
half after 5 o'clock until 6 they had recurred about every
five minutes. At when I first saw her, her breathing was
distinctly audible for a considerable distance; it had a shrill
croupy sound. In five minutes from the time I entered her
room, her head, neck, and upper extremities were violently
convulsed with spasms. These spasms first made their ap-
pearance about one hour previous to my arrival. They
would continue for a moment, and then with a distinctly
audible sound, like the dropping down of the valve of a bel-
lows, her breathing ceased. Cold water sprinkled in her
face and on her heart had no effect in causing relaxation of
the spasms. Ammonia held to her nose and rubbed upon
her temples was also without benefit. She seemed as if the
stamp of death was set upon her face; her eyes were livid
and rolled back in her head — lids wide apart; the pulse at
the wrist had disappeared. The ear applied over the car-
diac region revealed a feeble, fluttering, intermittent and
nearly inaudible sound of her heart, as if it were almost
overcome by the po vverful load that oppressed it in its strug-
gle to sustain vitality. Its energies were evidently sinking
with a fearful rapidity, as was indicated by each succes-
sive pulsation growing more and more feeble. This spasm
had now continued for near a minute. The delay of anoth-
er moment might be fatal. Instantly my fore finger was
introduced into her fauces. It caused her to make an effort
at vomiting, and with this effort the spasm relaxed. She
now drew a feeble, slow, sighing inspiration, whicji was
soon followed by a slow, weak, crowing expiration. Slow-
ly another croupy inspiration followed; and now respiration
was once more established, soon to cease again upon the re-
currence cf another fit of spasms, which was almost in-
stantly relieved, however, by the introduction of a finger
into the fauces.

Her pulse was rather feeble, but a large orifice was now
opened in the cephalic vein, with the hope that the abstrac-

1 28 Carriger on Spasm of the Epiglottis.

cion of blood might, from its relaxing influence, cause a
diminution both of the frequency and severity of the spasms.
This hope was soon disappointed. Syncope was nearly in-
duced by the abstraction of less than 8 oz; yet there was not
the slightest apparent amendment; — one paroxysm now
scarcely passing before the beginning of another. A large
blister was next quickly drawn by the application of a lin-
iment composed of 1 oz. aqua ammonia fort.; 1 oz.- sweet
oil; 2 Z camphor. A slight amendment followed this ap-
plication.

Every attempt to swallow caused the most violent fit of
spasms, consequently nothing could be introduced into her
stomach Two gr. sulph. morphine were now sprinkled
over the blistered surface. This caused a more decided
amendment; — in one hour the spasms having become much
less severe and being reduced in frequency to one in every
fifteen or twenty minutes.

An enema was next administered composed of 1 Z tinct.
opii.; 20 grs. camph., 5 grs. ipecac. In two hours after
this she was able to converse audibly, the aphonia having
almost entirely disappeared.

She complained of a little dyspnoea, a 'sense of choking,
and of something like a ball rising up from the stomach.
She was now enabled to swallow without difficulty 1 gr.
opium and 4 grs. camphor, which she continued to take every
hour for 4 hours; the spasms ceasing entirely after the se-
cond dose.

When the spasms had ceased for a couple of hours I left
her, directing half gr. opium and 4 grs. camphor to be given
every four hours through the day, and an occasional dose of
oil until her bowels were operated upon. From some mis-
understanding on the part of the nurse, the medicine w T as
not given, and in twelve hours from my departure the spasms
had returned, and in twelve hours more when I again saw
her, had become tolerably violent. They were, however,
soon relieved by camphor and opium. When the spasms
had nearly ceased, she took I oz. oil and 1 Z spirits turpen-

Carrigcr on Spasm of the Epiglottis. 129

tine, which in a few hours brought away a large quantity
of scyballa and a good many worms. The camphor and
opium were still continued every four hours lor the next '
twenty-four, and then discontinued. Carb. ferri and calomel
were then ordered three times per day. She was of delicate
habit of body, — had suffered considerably trom amenorrhoea
for several months preceding her present illness.

That this was a case of spasm of the glottis from the be-
ginning, we can hardly doubt, nor can we doubt that it was
intimately connected with or dependent upon hysteria. The
absence of the characteristic croupy sound for some hours;
her quietude and insensibility after suddenly falling down;
her previous state of health, might almost induce the belief
that her condition for the first few hours was but the lethar-
gic condition of catalepsy. But the diagnostic symptom of
catalepsy, the rigidity of the muscular system, was entirely
wanting; there being unusual flaccidity. But we may be
asked with propriety if this w r as a case of spasm of the glot-
tis "ab initio,? why was the characteristic respiration, the
crowing sound, wanting? We w 7 ould answer that there
may be spasm of the glottis and no croupy sound be heard
at all. Neither during complete relaxation nor during a
forcible, permanent, rigid contraction is it possible for any
sound to be emitted. Then in the present instance we would
account for the absence of the croupy respiration for the first
few hours by the supposition that the spasm was in the first
instance so complete and so rigid that there could be no
breathing during its continuance, and consequently no sound.
That it was so complete, so rigid, so permanent that the
feeble, flickering powers of life were weakened and reduced
to their lowest ebb, and that they were almost extinguished
before there was any relaxation, and that perhaps as the
flame of life was just about to be, extinguished the relaxa-
tion was all at once complete, thus enabling the vital pow-
ers to regain slowly and without further struggle some of
their wanted energies. Thus no abnornal sound was heard,
either during the continuance of the spasm or after its
complete relaxation.

130 Fleming on Acephalous Fail us.

Art. YI.-~£cephalous Fostus, communicated by Dr. R. N. Flem-
ing.

Mrs. E O'N , aged about forty ; corpulent ; of good gen-
eral health ; the mother of thirteen children ; in the seventh month
of gestation, complained, on November 5th, 1851, of pain in the
back, hips, and one knee. She had considerable oedema, espec-
ially of the feet and legs ; abdomen greatly distended and tight ;
constipation generally, from dislike to medicine ; pulse quick with
some firmness; tongue nearly natural. She was apprehensive
that abortion might take place, affirming that she couid not be fur*
ther advanced than the seventh month.

She was treated by venesection, an aperient, anodyne liniment,
and afterwards Tinct. Opii. These procured but trifling relief ;
and on the the evening of the next day there was an exacerbation
with an undoubted tendency to uterine action. This was attempt-
ed to be controlled by anodyne enemata, but without effect, and the
labor proceeded.

Examination per vaginam detected the os uteri in front of pro-
jection of sacrum, open to size of half a dollar; hot; unyielding;
membranes distended; foetus not felt. Venesection was again
practiced; the fundus uteri was elevated, and the os brought for-
ward. Ballotement gave the idea of something pointed sticking
against the finger, but receding, as if floating. The patient made
uncommon complaint of pain, especially of the back. Believing
the inefficiency of uterine action to be the result of over-distension
from excess of liquor amnii, the membranes were ruptured, and ex-
it given to an unusual amount.

In a short time, the face presenting towards right sacro-iliac sym-
physis, the foetus was delivered still-born. The labor was painful
beyond any seemingly adequate cause or condition of the patient
present.

The placenta came away naturally. The funis was vevy short,
infiltrated and thick.

The foetus was a male, of good size for one in the seventh month,
and normal in every part, except the head. There was a face ;
two pop-eyes ; instead of eye-brows, two gristly, heel-like ridges ;
and two little pendent ears — a face without a head !

From the place of the supra-orbital ridges the head went ofTinto
the foramen magnum, on a level with the zygomatic process and

Fleming on Acephalous Foztus. J 31

petrous portion of the temporal bone, the integuments and posteri-
or border of the foramen being wanting in the inter-space. The
gristly heel-like ridges, standing transversely, occupied the situa-
tion of the supercilia, which were wanting, and consisted of the
edge-like remains of the frontal integuments, with livid cicatrised
surfaces. The eye-lids, being somewhat encroached upon by the
cicatrised ridges, were unnaturally drawn up, so that they utterly
refused to remain over the eye-balls.

The removal of the integumentary attachments of the ears so
closely superiorly, without the compensation ot any such ridge,
gave them a fallen or prudent appearance.

The remains of the cranium, viz : portions of the frontal, parie-
tal, temporal, and occipital bones, naturally composing the superior
and expanded portion of the skull, lay flat on the base, having been
blighted at an early stage of their development, macerated, white,
making no elevation, with but very trifling, and apparently no liv-
ing connection with, the adjacent- structures. A suture, extend-
ing antero-posteriorly, was recognised as the sagittal, but without
any traces of the coronal or lambdoidal. Over these were spread
the remains of the pericranium — smooth, transparent, epitheloidal
and destitute of any trace of vascularity. This soon became dry
and cracked at what would otherwise have been the posterior bor-
der of the foramen magnum. A small probe introduced indicated
the presence of nothing, unless, perhaps the remains of membranes.

How far down the vertebral canal this state continued, was not as-
certained.

The body, though moderately small, was remarkably well devel-
oped and plump. It had been active, strong, and its movements
well distinguished and undoubted, up to the period, at which it be-
came closely engaged in the pelvis. Its intra-uterine maturity

was sufficient, cast eris paribus, to have afforded it a very fair chance
of living.

Leave could not be obtained to make any other or more intimate
examination.

Benton, Polk county.

Art. VII. — Periodical Neuralgia, read by Dr. B. B. Lenoir.

In October, 1847, Col. M. requested me to prescribe for

his wife, describing her case as follows: She has had very

severe pain in one side of the under jaw for more than a

132 Long on Typhoid Fever — A Revision.

week; it comes on three or four times a day with consid-
erable regularity, continues about an hour each time, then
subsides entirely. She has had three teeth extracted with-
out the least benefit.

P. Quin. sulph., 10 grs.; pul. ip. com., 5 grs.; piperine,
2i grs. m.; fiat. 10 pills, unusom noct.

When she had taken all the pills, she was entirely well,
and has had no return of the affection up to this time.

May 7, 1848.

Art. VIII. — Typhoid Fever — Jl revision of the Article, Pub-
lished in the Southern Medical and Surgical Journal, 1851,
by Dr. J. A. Long.

I do not propose writing a treatise on Typhoid Fever, but only
wish to record my own observations and experience in this disease.
I have no theory to support, or controverted points to settle, but
facts to state, as they have occurred to me in practice, from time to
time.

Since the spring of 1844, at which time I entered the practice
of medicine,, Typhoid Fever has become more prevalent, and Pe-
riodical Fevers less so. In proportion, as the jformer has increas-
ed the latter have diminished in frequency, until the past years,
which have been productive of Typhoid Fever — Periodical Fe-
vers, (intermittent and remittent,) were almost wholly unknown in
this section of country. Typhoid Fever prevails in this region in
an epidemic form, raging in a certain locality, or on some particu-
lar water course, whilst the adjacent country is entirely free from
its ravages.' Typhoid Fever is a disease that prevails at all sea-
sons of the year, but is most common here in autumn and winter,
the gravest cases occurring in cold and damp seasons. It attacks
families, and even whole settlements, without any known, or ap-
preciable cause.

In some families, one is taken down after another in succession,
until every form and stage of the disease can be seen at the same
time, and in this way, is sometimes prolonged in the family from
three to four, and even six months continuously.

The question whether Typhoid, and other forms ot Fever, be-
long to one and the same great family, or are distinct forms of dis-

Long on Typhoid Fever — A Revision. 133

ease, is, I think, an important one, and not yet satisfactorily settled.
It is one, however, that I do not intend at present to discuss.
There has been much said in this, as well as other countries, about
the name of this disease, and some of our oldest and most experi-
enced physicians still cling to the name of Nervous, Winter and
Typhus Fever, — whilst the community in general, believe it to be,
from its name, Typhoid Fever — a new dis ease that has appeared
among us, as it is so much more common than in former years. At
present I shall pass by all those discussions of the French and oth-
er writers, in regard to the different appellations that have been
given to the disease, by different authors. I will only mention here,
for the benefit of those who have not had an opportunity of consult-
ing Dr. Bartlett's, and other standard works on Typhoid Fever,
that it has been called entero-mesenteric ; by Petit and. Serres,
dothinenteriio; by Bretonneau, Enteric Fever; by Dr. Woods,/o^-
licidar enteritis, and abdominal Typhus by others. All these ap-
pellations going to point out the peculiar lesion, or affection of the
alimentary tube in this disease, and more especially that of the
small intestines, which I will notice more fully hereafter. But
the term, Typhoid Fever, in this section, is coming into general
use; all others, as Nervous, Typhus, Winter, Continued and Slow
Fevers are going into disuse. [In conversation with an old, expe-
rienced and retired practitioner, he said, he called it Typhoid
enteritis.'] I would here remark that, I am not entirely settled in
my own opinion whether that group of symptoms, which make up
the disease in question is really and strictly a Fever, or, whether
h should not be classed as above, with the diseases of the alimen-
"tary canal. The rise and progress of the disease; the peculiar
character of the pulse, so commonly noticed in other affections of
the bowels ; the local symptoms so early developed in a large ma-
jority of cases, referable to the iliac regions, and especially to the
right iliac and iliac fossa; the great danger of relapses from ta-
king solid food, and other articles of diet after convalesence — all
point the latter organ as the seat of the disease. Why then,
not call diseased action in any other part of the body, giving rise
to fever, a Fever, as well as the one under consideration, and not
an inflammation, with its appropriate appellation according to its lo-
cality ?
I am though, rather persuaded, that the treatment in this disease

j 34 Long on Typhoid Fever — A Revision.

would have been doubly successful if it had been known under some
title pointing out more fully the lesion of the small intestines— then
the disease would have been more fully prescribed for, and not the
name, as I fear is too often the case in the present day.

Typhoid Fever generally comes on slowly and gradually. So uni-
form is it in this particular mode of access, that it is one of the princi-
ple features in its diagnosis. I can not at present call to mind, a sin-
gle well marked case of Typhoid Fever, in which the onset was
sudden or violent, though occasional attacks of this kind may, and
probably do occur, from modifying causes, or from unusual predis-
dosing states of the system. I have almost uniformly been told on
my first visits to patients, that they had felt unwell for several
days, or perhaps weeks, and indisposed both to bodily and mental
exercise of any kind. They were, however, unable to tell in what
their disease consisted, more than weakness, or a general sense of
languor, anxiety, restlessness, disturbed sleep, &c. A dull head-
ache accompanies, or succeeds the above premonitory symptoms,
this being preceded in the majority of cases by a chill, chilliness,
or a sense of coldness; followed by fever, dryness of the mouth and
fauces, with the tongue more or less furred, dry, and occasionally
cracked ; surface dry and warm ; high colored urine, &c. The
febrile symptoms in Typhoid Fever are rather of a low grade or
type, with slight exacerbations, and remissions at some period du-
ring every twenty-four hours. Generally I have found the pulse
somewhat accelerated at night, accompanied with restlessness and
want of sleep, even in mild cases ; watchfulness, jactitation and
delirium, in grave ones. One of the most constant and character-
istic symptoms of Typhoid Fever, is Diarrhoea, and this symptom
is as constantly present in mild, as grave cases, and probably more
so. It is, however, occasionally absent,, in both the former and the
latter, being most uniformly present in cases of medium severity ;
and most generally absent, or wanting, in cases of either extreme.
This symptom, I believe, is always accompanied with more or less
abdominal soreness, particularly if pressure be made upon the
right iliac region. Most generally the tenderness is accompanied
with a gurgling noise in this part of the abdomen. This latter
symptom I have sometimes detected even before Diarrhoea had set
in. My patients have generally complained of fullness, and a dull
aching in the abodomen, sometimes, but rarely amounting to colic

Long on Typhoid Fever — A Revision. 135

pains. Some writers, as Wooten, of Alabama, have divided the
disease into two general classes, nervous and mucous, according as
one or the other of these great systems suffer most, or as the mu-
cous or nervous symptoms predominate in the disease. He also
gives us a set of mixed cases, where both the mucous and nervous
systems suffer equally alike ; and here it is, he says, we are most
apt to meet with those grave cases which, unfortunately for hu-
manity, are too often to be seen in this as well as other regions of
the globe. It is true, that the '.cerebrospinal system, as well as the
mucous, suffers greatly in this disease ; but in this locality, so far
as t am able to judge, those two classes of symptoms are so uniform-
ly blended in almost every case, that a division of this kind would
be of but little practical value. It is equally true, by hair-splitting
distinctions, that one or the other set of symptoms, mucous or ner-
vous, will be found to predominate in nearly every individual case.
This I attribute more to differences in constitution, age, sex, habit,
temperament, &c, than to any particular variety of the disease.
Typhoid Fever is truly a nervous disease, as is manifested by gen-
eral weakness, headache, delirium, loss of vision, deafness, ringing
in the ears, somnolence, vigilance, jactitation, muscular prostra-
tion, &c. Epistaxis is a pretty constant symptom in this fever, as
well as occasional hemorrhages from other parts of the body ; but
that form of hemorrhage which is most to be dreaded in this form of
fever, is melalna— destroying the patient at times suddenly, with but
little signs of its approach. The delirium is of a low, muttering
kind, attended with watchfulness, jactitation and picking of the
bed clothes, though occasionally it is wild and furious ; the patient
rising from his bed and striking at his attendants, or pulling at,
scolding, or menacing some imaginary object about his bed. I
have seen them even leap from their beds, and traverse the room
in which they lay, giving considerable resistance to those who at-
tempted to oppose them. Patients in general can be easily arous-
ed when distinctly spoken to, and will then answer questions in
relation to their situation, or feelings, perfectly rationally, but as
soon as left alone, will sink back in their former state of stupor,
saying nothing except what is forced from them by repeated ques-
tioning. They generally reply that they feel better; nothing
is the matter; they are well, and so on. For several years I
was induced to believe, from many and repeated examinations,

136 Long on Typhoid .Fever — A Revision.

and comparisons, that the puise*in Typhoid Fever was peculiar and
characteristic, — small, quick and frequent, — having a kind of dou-
ble beat, or, as Dr. Bartlett calls it, the bisperiens pulse, ihe artery
rebounding after sinking. So constantly did I find this pulse in
Typhoid Fever, and so seldom in other diseases, that in a locality
where this disease was prevailing, I could almost make out my
diagnosis from this symptom alone. But not so uniformly is this
the case at present — more observation and experience, a gradual
change in diseases, epidemic influence, or these Causes conjointly
— abundantly show, at present, that most of acute diseases are
attended with a Typhoid pulse, in some stage of the disease.
I generally find the pulse in Typhoid Fever, from 90 to 110 in
men ; and from 100 to 120 in women, m common cases. But in
grave cases, or where some local disease is present, the pulse
ranges higher, from 110 to 120 in males, and 120 to 140, or even
as high as 150 in females. In many cases of Typhoid Fever,
from extreme nervousness, or twitching of the tendons, (siibsultus
tendinum,) the double beat of the pulse, or apparent reaction after
every pulsation, and its almost unparalleled frequency, renders it
impossible to count the pulse with correctness in this disease. I
have seldom seen nausea, or vomiting in this fever, or even much
complaint of pain, or other disagreeable sensations in the epigas-
tric region. Much has been said, and many contradictory state-
ments have been made, about the state and condition of the tongue;
some asserting that this organ differed but little from its natural
and healthy state in every stage of the disease, whilst others con-
tend that the tongue exhibits various unhealthy appearances. I
have always found the tongue more or less coated with a white,
yellow, brown, or even black coat ; moist, dry, cracked, or swollen,
according to the severity of the disease. The appearance of the
tongue indicates, to the experienced practitioner, the extent of dis-
ease in the alimentary tube in most cases. When there is much
soreness of the abdomen on pressure, accompanied with obstinate
Diarrhoea, the tongue is found swollen, with a yellow, dark, brown,
or black coat, with its tip and edges more or less red. I am ready
to admit, however, that in mild cases the tongue shows only slight
deviations from its natural appearance.

Some patients are so slightly attacked, that they never take their
bed, whilst others are rapidly hurried to a fatal issue. At other

Long on Typhoid Fever— A Revision. 137

times, (and this is most commonly the case,) the disease is slow,
tedious and lingering in its nature, and sometimes many days, and
perhaps weeks, elapse and pass off, leaving the friends still in a
state of restless suspense, as to whether life or death will finally
gain the ascendency. Typhoid Fever is mostly confined to the
young and middle aged, or to those between the age often and thir-
ly years — rarely attacking those younger than ten, or older than
thirty. This disease is evidently contagious — this is strikingly
true in the grave forms of the disease, where large families are
crowded together in small apartments, illy ventlated — and where
it is impossible to observe cleanliness, as it should be done in a
sick chamber, by removing all unnecessary furniture, clothing, and
the discharges of the patient, requisites so essential to the promo-
tion of health, and avoidance of disease, not only Typhoid Fever,
but all other diseases incident to the human family. I have seldom
seen a single attack in a family ; but so often have I witnessed it
running through whole families, — the young and the old only es-
caping, — and scattering, throughout the neighborhood, to atten-
dants, connexion, &c, that little doubt is left, as to its contagious
nature. I have usually found that the first attacks that occurred
in a family or neighborhood, were generally the severest. It is un-
like Periodical Fevers in this respect, as the latter generally come
on in their mildest form, gradually growing severer with the ad-
vancement of the season. I would further remark, in proof of the
contagious nature of this disease, that I have never seen the same
individual suffer more than once from Typhoid Fever, notwith-
standing I have seen the disease in the same family at different
times ; attacking the remaining portion, especially those that were
the most obnoxious from age, and leaving all such as suffered from
previous attacks with as much impunity, as in Measles, Scarlati-
na, or Varioloid.

There is so much to be learned in Typhoid Fever, from the
physiognomy of the patient in every stage, that I am always anx-
ious, on my arrival at each visit, to catch a glimpse of my patient's
countenance, which never fails to make a decided impression on
my mind, even before any further examinations are made, or ques-
tions asked. A rose colored eruption is spoken of by almost every
writer on this disease, but it is seldom seen, unless looked for at a
proper stage of the .disease ; also sudamina are met with in a small

13S Long on Typhoid Fever — A Revision.

portion of cases. This latter symptom, I have observed as often as
the rose colored eruption. The eruption is most apt to be found
upon the anterior portions of the chest and abdomen, but occasion-
ally it is scattered all over the body. I find by consulting my
case book, in a few of my grave cases, that I have encountered
some very obstinate eschars or bed-sores, mostly on the hips and
sacrum, I have also seen deep idcerations, or obstinate sores, pro-
duced from blistering in Typhoid Fever, especially on the lower
extremities. There is generally slight cough with little or no ex-
pectoration, though occasionally it becomes troublesome, with free
expectoration streaked with blood, or of a rust color — according as
the bronchia, or parenchymatous substance of the lungs is more or
less effected. This latter symptom is accompanied with dullness
on percussion of the chest and other symptoms denoting more or
less congestion of the lungs, or pneumonitis.

I have observed Typhoid Feverpar taking more of an inflamma-
tory nature, not only in different seasons, but in diffeient settle-
ments or localities the same season. The diagnosis in this dis-
ease is attended with some difficulty in sporadic cases only. But
in seasons remarkable for the prevalence of Typhoid Fever, its
mode of access, its attacks on whole families and settlements, ra-
ging mostly in an endemic form, its slow and tedious nature, attend-
ed with a Diarrhoea, render the diagnosis comparatively easy.
When the above symptoms are accompanied with fever, a quick,
frequent and small pulse, with a double or reacting beat, ranging
from 90 to 140 beats in a minute, soreness on pressure over the
right iliac region, with a gurgling noise, occasional tympanitis,
with an unusual degree of weakness, epistaxis, headache, that goes
off in the course of the first week, whether medicine be adminis-
tered or not, — when all, or a large portion of these symptoms are
found in a patient, between the ages of ten and thirty years, are
sufficient to establish a case of Typhoid Fever. The prognosis in
this disease is attended with some difficulty, as some grave and pro-
longed cases terminate in recovery, whilst we are told, that occa-
sionally mild ones terminate rapidly in death, by peritonitis, from
perforation of the intestine. But, as a general rule, where the
case is not complicated with acute local affections, or chronic dis-
orders, or on already broken down constitutions from previous dis-
ease, or otherwise, and where the pulse does not range higher

Long on Typhoid Fever — A Revision. 139

than 100, or 110 in men — 110, or 120 in women, the case will ter-
minate favorably, if the treatment be appropriate and not aggra-
vating, as is too often the case. According to my own experience
the prognosis in Typhoid Fever is, for the most part, favorable,
the disease having a strong natural tendency to terminate in recov-
ery in its uncomplicated form, even when left to run its own course
without treatment. Bile in the discharges, where it has been ab-
sent for a length of time, is always to be looked upon, as a favora-
ble symptom ; — and more especially is this the case, when accom-
panied with other favorable signs, as it usually is. The discharg-
es are generally watery, of a green, or dark green color, without
any traces of bile in them, and mostly without smell. [I am aware
that this is a controverted point, but I write only what I know to be
facts, and I have almost uniformly found the stools of Typhoid Fe-
ver, when Diarrhoea was present, to be without smell ; and I have
often predicted a favorable change while the patient was at stool,
by perceiving distinctly a strong bilious smell to the discharges.]
I have frequently seen grave and prolonged cases terminate favor-
ably, but have not seen mild ones terminate unexpectedly, by peri-
tonitis, or otherwise.

If it were not for the daily reports of physicians, Medical jour-
nals, and newspapers, of a large proportion of deaths taking place
from this disease, in different portions of the country, I would ven-
ture to speak in more positive and favorable terms in relation to
the prognosis. In low and grave cases, the patient lies on his back
in a state of stupor, and slides down in the bed from muscular
weakness. One of the first favorable symptoms to be noticed in
such cases, is a tendency to turn on the side himself, or even ask
to be turned. When this position can not be maintained but for
a few moments at a time, but is daily repeated, it indicates return-
ing muscular strength — consequently a favorable change in the
disease.

Treatment. — The different modes of treatment, heretofore laid
down by practical writers, have only served to confuse and con-
found the young practitioner, and in the language, of Dr. J. S.
Wilson, "old ones, too." The mercurial course, so generally ad-
mitted to be the best in some of the other varieties of fever, in Ty-
phoid Fever, is not only useless, but positively injurious, if pushed
to the extent of obtaining only a slight impression on the system.

140 Long mt Typhoid Fever — A Revision.

The treatment of Typhoid Fever should be mild, and strictly eclec-
tic, to be successful, for no exclusive, or specific mode of treatment
can be laid down, that would be applicable, even in a small pro-
portion of cases. Typhoid Fever is a disease, that can not be cured,
but can be safely conducted through its different stages, by a ju-
dicious course oj treatment. We must meet symptoms as they
arise in each and every individual case, and endeavor to correct
the morbid functions of the different organs, and keep them in as
healthy a condition as is compatible with the nature of the case —
suffering the disease to run its course, as other specific disorders.
With these remarks, I proceed to give my own mode of treatment
in this disease, which has been attended with a loss of only about
one per cent, or three deaths in two hundred and eighty-three cas-
es. My course of treatment is plain, simple and mild ; in this re-
spect, not unlike the prescription given to Naaman of old, by the
prophet Elisha. I attack the disease not with a view to cure, but
to safely conduct the patient through the different stages. So un-
iformly is this my course of practice, and so thoroughly am I con-
vinced of the utility of such a course, that I speak of conducting my
patients safely through the disease, and not of breaking the fever,
as is the common term, especially among the vulgar. A great
man, and practitioner of medicine, once, on being asked what he
thought of a certain treatise on fever, replied, "he did not like Fe-
ver curers. A Fever" said he, "can be conducted safely through
its different stages — it can not be cured." These remarks on Fe-
ver, by the great Dr. Pitcairn, are applicable in every particular to
the treatment of Typhoid Fever.

When the patient is stout and robust, I take some blood, not be-
ing in the least governed by the quantity, or quality of the fluid
drawn, but its effects upon the heart and arteries ; but Typhoid
F^ver is so insidious in a great majority of cases, that th-e practi-
tioner is not called in until the bleeding stage has passed by — if
it ever existed, which it does not in a great majority of cases.
The functions of the skin and liver are generally suspended through-
out the entire course of the disease ; unless in very mild cases, the
former being warm, dry and harsh to the touch, and generally, of
an unusually yellowish hue, whilst there is no trace of I ile in the
alvine discharges. After sufficient blood is taken, where blood-let-
ling, either general or local, is deemed proper, I am governed by

Long on Typhoid Fever — A Revision. 141

the circumstances of the case. If Diarrhoea is present, which is gen-
erally the case - , and no traces of bile in the alvine evacuations, I give
from three to five grains of Blue pill with Dover's powders, and
the Blue pill may, or may not be repeated, according to circumstan-
ces. I watch narrowly the effects of the Dover's powders in every
instance, as that medicine is not borne well by some patients ; but
in a majority of cases it is not only tolerated, but produces the hap-
piest effects. If this does not check the bowels, I add a small propor-
tion of Sugar of Lead to each dose, until the Diarrhoea is effectually
checked. The bowels may be allowed to remain inactive, without
risk, for twenty-four hours, or even forty-eight hours, when they
should be opened by Castor oil, or, what is better, a mild injection.
Gum Arabic, Elm water, or Flax-seed tea, should be used freely,
throughout the whole of the disease ; and nothing should be allow,
ed as nourishment, but the mildest liquid diet, and that in small
quantities. This course of dieting should be oberved throughout
convalesence, very gradually increasing the quantity and quality
of the food, to prevent relapses, which are very common and dan-
gerous in this disease. Purgatives should be avoided, or entirely
withheld, as they do no good, and always set up obstinate and un-
governable Diarrhoea. In fact no active treatment is tolerated in
this disease, and more especially is this true of purgatives, emet-
ics, and the specific action of Mercury; I have seen the system, in
mild cases of Typhoid Fever, under the influence of Mercury with-
out checking the disease in the least degree, but in the general,
making a more tedious case. But to salavate a patient in a grave
case of Typhoid Fever, I think almost [impossible, — (I liked to
have been positive,) — unless the constitution be able to withstand
the disease and the medicine, until nature begins to ameliorate the
symptoms ; then, and not until then, can ptyalism be induced. I
have witnessed the administration of calomel from five to ten grain
doses, every three to six hours in addition to the use of an incred-
ible quantity of mercurial ointment, without the least sign of sal-
ivation ; but the perfect and almost irrecoverable prostration of the
patient.

The best knowledge a practitioner can have, in the treatment of
Typhoid Fever, is to know when not to act ; to meet plain indica-
tions, with the mildest means in his power, and give time. One
of the most common and dangerous effects of calomel, in this dis-

142 Long on Typhoid Fever — A Revision.

ease is hemorrhage from the bowels. Blisters are excellent rem-
edies in this disease, when indicated and well timed, applied to the
lower portion of the abdomen, when there is great soreness on pres-
sure, with, or without tympanitis. When the latter symptom,
tympanitis, is present, they sometimes pfoduce the happiest effects.
Blisters may be applied to the nape of the neck, when the deliri-
um, in grave cases, is wild and furious; to the side, or other por-
tions of the body, where pain is seated, or , even where pain has
been complained of in the onset of the disease.

Under such circumstances they seldom, or never fail to produce
the most satisfactory results. The patient will be greatly benefit-
ed in all cases, by having his hair cut short, and apply cold to the
head, where there is much heat of this region. The body should
be sponged daily with warm water, or water and vinegar, and the
patient's body well dried — this never fails to add greatly to his com-
fort. Daily sponging- is too much neglected, in the treatment of
all Fevers, and especially that of Typhoid Fever. Strict attention
should be had to changing the patient's clothing, and bed clothing,
in all cases ; ar.d more especially in graver ones, as this not only
contributes greatly to the eomfort of the the patient, but is one of
the principal means to prevent the spread of the disease. In mild,
and even common cases, little, or no medicine is required, beyond
the free use of mucilaginous drinks ; entire abstinence from solid
food ; rest in the recumbent posture, &c, &c.

I have seen patients exhibit nearly all of the pathagnomonic
symptoms of Typhoid Fever, which continued from three weeks
to one month, that never took their beds, for two hours at a time —
and no medicine, save an occasional dose of Castor oil, fomenta-
tions to the abdomen, &c. But in grave cases, we have the sys-
tem to support, by the occasional use of tonics and stimulants ; to
combat inflammations of the variousjorgans; correctjmorbid secretions
so far as this can be done by mild means, and no farther — for to cut
' short the disease, is equivalent to endingthe lifeof the patient. There
is a good deal said at present, in some of the southern journals
in favor of the use of veratrum viride, in Typhoid Fever, and es-
pecially, its great efficacy, in controlling the frequency of the
pulse, not only in this, but other severe forms of disease. Whilst
I am willing to admit its great controlling power, over the heart
and arteries, in many, and so far as I have tried it, all diseases — I
regret to state my belief in its entire inability to cut short the dis-
ease one hour.

Long's ^ Roads, McMinn county, May 17th, 1852.

McNutt on Pseudo- Typhoid Fever. 1 43

Art.. IX. — Pseudo-Typhoid Fever: £n Inaugural Thesis, pre-
sented to the Faculty in Medicine of the University of Nash-
ville, by Dr. Jas. McNutt.

The term Pyrexiae, derived from the Greek, and signifying fire
or to burn, has been adopted and is yet retained as a nosolog ical
distinctive, embracing Fevers and Inflammations. Though the
characteristic feature of heat or enhanced warmth, is very gene-
rally observed as an element in the symptomatology of the affec-
tions classed under the generic term Pyrexias, yet it is not unfre-
quently absent, indeed, sometimes the surface is below the natural
standard. It is evident, therefore, that other phenomena are ne-
cessary to constitute a pyrexial disease/

Though it is true that a fever exists, when arterial excitement,
heat of the surface and thirst are present, it by no meansjfollows that
these are necessary to constitute a Fever. Indeed there is no dis-
turbance of the human organization which occurs, in which a fe-
brile element is not recognised by the physician, even though it
may be impossible to describe it in accordance with the restrictions
of nosological arrangement. This fact furnishes an explanation of
the inability of physicians to tell the anxious friends of a sick man
the exact nature of his attack, until he has observed it in its pro-
gressive development. The initiatory stages of febrile attacks,
however diversified their developments and terminations may be, are
assimilated, — essentially alike; — and it is wholly impossible for the
attending physician from premonitory symptoms to decide wheth-
er the attack is Intermittent, Remittent, or Continued Fever. Or
whether it may not be Small-pox, Erysipelas, Measles, or Scarlet
Fever. Under such circumstances a practitioner of some eminence,
of the city of Nashville, when asked the character of a Fever which
a young gentleman just arrived in the city, was laboring under,
replied, "it may be Intermittent, Remittent, or Typhoid Fever, or
it may be Small-pox, Measles, or Scarlet Fever." And another
practitioner, an acquaintance of mine, who was called to see a patient
in the cold stage of afebrile attack, on being asked the character of the
attack answered — "she is now laboring under a chill, if that passes
off, and is followed by a fever, I will then say she has had a chill,
which was followed by a fever." And under the same circum-
stances, another East Tennessee practitioner, Dr. Harrison, with a
candor and honesty worthy of imitation, said, "I don't know."

1 44 McNutt on Pseudo -Typhoid Fever,

After the attack has continued a sufficient length of time, and
been observed under diff*er#it circumstances, we are enabled, with
the assistance of a knowledge of the nature of the locality, and the
character in the general, of prevailing diseases of the neighborhood
at the time, or previously, and of preceding attacks of sickness of
the patient, if within a period sufficiently recent to be presumed
to have an influence at the time of making observation of the exis-
ting disease. These circumstances, in connection with a knowl-
edge of the prevailing epidemic constitution, will be sufficient for
the intelligent practitioner to determine to his own satisfaction, and
consistent with his own character and the interest of his patient,
the intimate nature of the disease which is to be treated, whether
the books, or the ever changing nomenclature of the profession,
furnish a name or not.

The epidemic constitution is often mentioned, but seldom cor-
rectly investigated by practitioners. If this were more ordinari-
ly enquired after, and attempts to force symptoms into combinations
under specific titles were less frequent, the profession would not
be so troubled, and its literature so encumbered, with reports un-
der the same designative term, but presenting the greatest possible
contrariety of treatment and results. During the same season
different localities, or the same localities at different seasons, char-
acteristic symptoms present a higher or lower grade, and are more
or less easily subdued by appropriate treatment. To a want of a
proper apprehension of this fact, in my humble opinion, is to be
ascribed the very general prevalence of late, of the now fashionable
disease, Typhoid Fever. That there are cases of Typhoid Fever
essentially such, I have no doubt. But 1 do doubt just as little that
a large majority of the cases which have occurred and have receiv-
ed the name of Typhoid, were in truth our old acquaintance, Re-
rnittent Fever, in a new and slightly different dress, the disguise
probably being more complete by the addition of a foreign mustach
- — the more easily impressed bowels. But it is a fact that disease
with every thing is subjected to the caprices of change, in name if
nothing else, in the progress of civilization. We all know % that the
old fashioned distemper, or cold in the head is now nothing less than
Influenza, and it would be sealing his own defamation, for a practi-
tioner of these days and times to have a case of old fashioned Bil-
ious Fever. Yet many, very many of these cases are to be cured,

McNutt on Pseudo - Typhoid Fever. 145

and in no other way, than by the judicious administration of qui-
nine. Of late the inflamatory and c ongestive elements are not so
high, the system is less suddenly shocked, and the remissions are
therefore in the general less completely marked ; and yet if they
be diligently and carefully sought after, they will be discovered
ia operation, slowly but not the less surely, undermining the very
fountains of vitality.

There has been, and is at this time, prevailing in this town, and
the adjacent country, a form of fever, which the practitioners who
have it to meet, for the most part call Typhoid Fever. I myself,
though I recognise the difference in part, was accustomed to call
it Typhoid Fever, yet I did not lose sight of the essential feature
of remission, and treated it accordingly.

Since I have had the pleasure of hearing the very able lectures
of our Prof, of Practice, in the Nashville University, Dr. Bowling,
on the subject of Typhoid Fever, I am convinced that this form of
disease, which we have been and are now meeting daily, is Remit-
tent Billious Fever, prevailing under a low epidemic constitution.
To this I have chosen to give the title of Pseudo-Typhoid Fever.

The stage of incubation, is but little different from that of other
fevers. For a greater or less number of days perhaps weeks, the
individual complains of great muscular debility, though experien-
cing a constant disinclination to remain at rest. Any hurried
movements, however short their continuance, excites the pulse to
a hundred, and sometimes more pulsations a minute, — the force be-
ing feeble, and the volume small. This excitement of the circula-
tion is accompanied with hurried, and sometime laborious respira-
tion. The symptoms are allayed, by the affected person assum-
ing an easy position, and remaining quiet a sufficient length of
time to enable the disturbed organs to exercise their function with-
out effort. The same diseased evidences would be given by the
patient, from the exertion necessary to ascend a hill, or a flight of
steps. Disinclination to mental action, and almost total indifference
to the affairs of life, are ordinarialiy observed as symptoms of this
disease.

These increase in intensity for an indefinite period, until ulti-
mately, giddiness and wandering, lacinating pains of the head are
experienced, and disinclination to take food, though the taste re-
mains unaffected, a clean tongue, or, but very slightly, if at all, al-

146 McNutt on Pseudo- Typhoid Fever.

tered from a healthy, normal condition. After these symptoms
have been observed, and those which are active have continued a
few days, the patient is seized with rigor, more or less severe, and
generally in the morning before getting out of bed. The rigor will
continue from two to six hours, when it t will be succeeded by a
condition, consisting of alternations of slight chilly sensations and
warm or hot flushes, and which condition continues for twelve to
twenty hours ; the patient complaining of cold, it at any time his
body or the bedding is moved, even slightly. At the end of about
twenty hours, occasionally a less time, this condition gives place to
a permanent febrile state, which is very high for six to twelve hours.
The heat of this stage is not generally diffused, being more notably
observable about the head, face and hands, than other parts of the
surface, the inferior extremites being relatively cool. It is at, or a
little before this period, that the tongue is discovered to be discol-
ered, presenting a whiteish surface, with slightly reddened edges,
and broader and softer than natural. Soreness on pressure over
the epigastric region, with nausea and vomiting in most cases, but
by ho means uniformly. In a large majority of those attacked, Di-
arrhea is an urgent symptom, yet in some, the reverse prevailed,
the cosuveness demanding a frequent application of rather stimu-
lating injections. The matter of ejection is fluid and billious, and
those of dejection fluid , yellow or brown very offensive to the nose,
and almost wholly destitute of any feculent matter.

About the third or feurth day after the febrile stage assumes the
ascendency, the pulse falls to fifty, or sixty beats to the minute-
far below the pulse of health, and though very small and remarka-
bly feeble, is quite regular. In some persons an intermittent pulse
is observed, giving one considerable uneasiness, but I do not dis.
cover any difference in the course, or result of the attack, between
those with regular, and those with intermittent pulse.

During this stage the skin is cool and dry ; thirst by no means
urgent ; and though water is frequently called for, one swallow for
the most part, is sufficient to satisfy the patient, who complains
that it does not taste natural. When questioned as to his feelings,
the patient replies, weakness and sickness at the stomach, and as-
serts his firm belief that all that is wanting, is the removal of these.
Pain is not complained of, but is elicited, generally of a dull, but
occasionally of an acute character, by pressure over the epigas-

McNutt on Pseudo- Typhoid Fever. 1 47

trum. If very closely questioned, patients will complain of a sen-
sation of tightness across, or in the chest; and though cough is
not a feature of the earlier stages, it not unfrequently presents du-
the course of an attack, and sometimes accompanied with puru-
lent expectoration.

Convalescence generally commences about the eleventh, and
occasionally as late as the fifteenth day, from the development of
the active symptoms. The first case which occurred to me for
treatment, continued until the latter part of the third week, before
convalescence was established. This case was not medicated with
that greatest of all anti-malarious reagents, which I invariably used
with other cases, I mean the Sulphate of Quinine, and to the fact
of its omission I ascribe the delay of convalescence. No case of
death occurred in the practice which regarded the Sul. Quinine
as the chief dependence.

But such success does not attend the efforts of those who view
the disease as pure Typhoid Fever, and who shape their treat-
ment accordingly — treating the disease from a name, instead of
closely observing and employing a rational therapeutics.

It now only remains for me rapidly to sketch the manner of treat-
ment which I have adopted, and from the allusion already made to
results, may it readily be supposed that I 'have no disposition to
change, or cause to regret having adopted it.

I commonly commence with a mercurial, — Calomel, Blue-pill,
or Mercury and chalk, according to the state of the bowels, — and
these in combination with Rheubarb, if I wish purgative action to
be more prompt. At the same time I apply cups, and follow them
with mustard poultices to the surface of the stomach. By this
means I allayed, or wholly subdued the nausea and vomiting, and
precordial distress. If after the employment of these means an
intermission does not occur, and the nausea and vomiting continues,
or having been allayed, returns, L apply a blister over the region of
the stomach, and afterwards dress the denuded surface with an
Elm poultice. At the same time I commence the use of two and
a half grains of Blue Mass, and a sixth of a grain of Acet. Mor-
phia—repeated every three hours, and continued until fifteen grains
of Mass, and one grain of Morphine have been taken. The pa-
tient should be allowed cold water at pleasure, and an occasional
effervescing mixture will be found productive of good results.

] 48 McJSutt on Pseudo- Typhoid Fever.

The Morphia is particularly useful in such cases as have Diar-
rhoea as a symptom or condition, but sometimes it will cause too
great a degree of confinement of intestinal matters. Under such
circumstances a tea spoonful of Castor oil, administered a few hours
after the first pill has been taken, will ordinarily produce sufficient
action. If, however, such a result does not follow, mild injections
should be resorted to, rather than risk exciting the bowels too much
by the further administration of purgative medicines, however
mild, by the mouth.

During the progress of the above treatment, an intermission will
occur, which should be promptly seized upon, and a few regula-
ted and properly apportioned doses of Quiuine, will equalize the
functions of the organization, contravene the operation of the mal-
arious poison, and perfect the restoration to health of the the pa-
tient.

My habit has been to make a pill composed of two and a half
grains of Quinine, and a sufficient quantity of Liquorice Extract,
and administer every two hours during the intermission; — some-
times circumstances presented, inducing me to give two pills, at
the same intervals. Generally three or four doses were sufficient
to stop the access of Fever, but I ordered the repetition the next
day, or in some cases the next day but one.

After the fever has wholly subsided, which is indicated by the
pulse rising, becoming more full, and the skin assuming a softness
and elasticity ; the tongue getting clean, and the appetite return-
ing, I then order one of the pills to be taken three times a day— .
morning, noon and night — for a few days. The convalescence in
the cases I observed, either in the practice of others or myself, was
remarkably slow, requiring several weeks for the patient to recov-
er entire strength. I never had a patient with this fever to relapse.

A remarkable feature of the disease is the larger majority of fe-
males attacked, — a proportion of about three females to one male,
occurred in my practice. In the females the Fever was generally
developed about the period of their monthly turns, but it was not
observed that the attacks were of greater severity, or the disease of
longer duration in females than males.

Kingston, Tennessee.

Ramsey's Report. 149

Art* X. — Report on Practice, by Dr. Frank A. Ramsey.

At the close of the last year, for the purpose ot aiding a committee
which had been appointed by the American Medical Association, I made a
tabular statement of the cases which had presenied in my practice, from
April to December inclusive. I propose now to present a like tabular
statement of the cases occurring from January to April inclusive, of the
present year, in the practice of Dr. Mcintosh and myself.

The chairman of the committee, to whom I forwarded the tables of last
year, informed me that he had intended me the honor of proposing to pub-
lish them in a popular professional periodical, had I not requested their
return for the purpose of publication at home, in a journal issued under the
auspices of this Society ; and the reason he assigned was, because the pub-
lication of such papers seemed to him peculiarly desirable .Of

the correctness of his judgment in this particular, I am fully persuaded;
and if I had an influence with the medical men of East Tennessee, it
would be exerted in inducing them to make faithful exhibits of their prac-
tice and results. The effect of such a course would be highly beneficial
on many points yet under investigation, or but dubiously settled, such as
the ratio of mortality in the general, as well as the ratio of mortality to
adults, children, male and female, white and colored, — the peculiar diseas-
es of particular times and places, and the salubrity and insalubrity of
different locations, — the origin, course and force of epidemics, and the pe-
culiarities of different modes of practice. And again. The cry of Reform
has been raised. Emanating from medical men, it is being reiterated by
the public, and for this cause many who should be overwhelmed with
shame and wounded honor by the cry, have taken it up, and like the man
who stole, have joined the pursuing crowd, and more loudly than the rest
vociferate — Stop thief! Reform! Reform! This fact is well appreciated,
but as yet no decisive measures have been adopted to determine who are
conscientious in their desires, and who cry Refoim from sinister motives.
The American Medical Association, composed of practitioners, and college
professors, has passed resolution upon resolution for the benefit of the pro-
fession, calling earnestly on practitioners and prolessors to give them prac-
tical importance, —and though they remain amongst the records, their
good effect is hardly viside. Pages have been written and columns print-
ed, and bui little accomplished —the waters continue troubled, and the
calm is not yet. The word Reform has become stale, the time has passed
for wind work to be effective, and action now is necessary. The Ethics
ot the profession, founded as they are in wisdom, denounce direct appeals
to the people, and the public therefore must be reached through the profes-
sion. Then let the Ethics be in every particular observed, and laying

150 Ramsey's Report.

aside all personal animosities, and shaking off the influence of conflicting
pecuniary interest which arises in the field ol competition, let us be . v-
erned by the noble and ennobling motive of benefit to others and good to
self, and from time to time submit ourpraciicp and the results to our com-
peers for vigorous but fraternal scrutiny. It is from high authority that
the command is given, to be ready with a reason for the faith that is in
you, and should not be forgotten by medical men in the discharge of their
benign (if not pernicious) services to the sick. And to whom sha 11 this rea-
son be given? Certainly not to the patient, the patient's friends, or the pub-
lic. These can not apprehend the difficulties which the mind and judg-
ment of the physician contend with; cannot understand why doubt should
be permitted to exist ; nor appreciate the great anxiety which sometimes
attend the adoption of a particular line of practice. Such can only be ap-
propriately presented to those, whose investigations and reflections have
been spent uron the human organisation, and the relations which it .sus-
tains in health and disease; — and when properly stated will either improve
those who hear and read, or lead them to make statement and give reasons
which will prove of incalculable advantage to the reporters. And the peo-
ple who rely di professional advice for their bodily and mental comfort,
will soon perceive that they have nothing to fear — that physicians are not
men who look to the pains and aches ef poor mortality, as the tradesman
does to wares- but are truly laborious in the cause of humanity for hu-
manity's sake; and thus convinced, the public will freely and voluntarily
lend its aid in its might to discountenance every form of empiricism, every
individual imposture, and to the sustenance of legitimate medicine and the
good physician.

Ramsey's Report.

1S1

JANUARY, 1852.

Diseases

blunder 1515 to 35 over
T

Erysipelas,

Dysentery,

Croupy Catarrh,

Catarrh,

Chronic Cough,

Fever, Intermit.,

Fever, Remittent,

Ephemera,

Otorrhea,

Constipation,
do

Colic,

Jaundice,

Sore Throat,

Tonsiletis,

Tonsils Indurated,

Pneumonia,
do

Consumption,

Paroted Indurat'n,

Childbed,

Burn,

Teething,

Accidents,

Breast Bealed,

Breast Indurated,

Parturition,

Puerperium, un-
pleasant from
Constipation.

Painful Micturit.,

Amenorrhea,

Menorrhagia,

Ulcer'nof Uteri,

Ovaritis,

Albuminuric,

Perineal Abscess,

Eclampsia,

Tumor Excision,

Anemia,

?: M

vv
W

w
w

w
w
w

b
w

b
w
w
w
b
w

•w

iV!

F M

9 7 16 26 3
Of this total, two resided in the country

To-]

t al .'

~ i
3
3
4
1
2
A
1
2

DEATHS

15 to 35 ov.

1 1

To-
tal.

Erysipelas. — Habitual, of the forehead, face, and scalp. Pa-
tient asthmatic. Has not been severely attacked with Erysipelas
for two years ; and thinks that an attack was jugulated one year ago
by the free use, locally, of Sulphate of Iron. The same application
had been used on the first manifestations of this attack, and con-

152 Ramsey's Report.

tinued probably a week, in connection with saline and mild veo-e-
table purgatives, but inflammation continued to progress. A Calo-
mel and Jalap purge was given, and repeated after forty-eight
hours, and the local application of Sul. Iron continued. For a
fortnight the inflammation seemed to be held in obeyance, when it
broke out with renewed fury. Purgative doses of Calomel and
Jalap were given on alternate nights, — the second producing alarm-
ingly excessive depression. Mur. Tinct. Iron, in doses of twenty
drops every six hours, was immediately commenced, and in less
than forty-eight hours it was manifest that the disease was pass-
ing off*. The convalescence, however, was slow, the cellular tis-
sue becoming involved, discharging a thin, sanious matter, and de-
generating into sores. The Iron was, however, perseveringly
continued, and the patient finally restored to ordinary health.

Chronic Cough, — A negro wench. No inflammatory symptoms
were presented — physical examination did not expose any disease
within the chest. It seemed to be nervous, and consisted of an im-
mense number of violent, dry clicks, continuing sometimes without
any interruption, except an occasional deep inspiration, for an hour,
completely exhausting her. Opiates and Assafcetida simply mitiga-
ted ; other agents produced no effect. She was finally removed
from the county.

Remittent Fever. — The eldest female patient was gestating, and
did not bear Quinine at all. The remissions occurred daily, for
two weeks, but finally ceased under the influence of Salicine.
This article, in the few opportunities I have had to observe its pow-
ers as an anti-periodic, has impressed me very favorably. It must
be remarked, however, that the cases in which it has been tried
by me, were in every particular mild — the system of the patients
giving no manifestations of disease, other than heat of surface,
quickness of pulse, some thirst, and very slightly furred tongue,
and indisposition to exertion, with very distinct remissions. In the
case under notice it rapidly and positively subjugated the paroxys-
mal feature, together with the thirst and heat of surface, while the
appetite returned, and the tongue became clean ; but the patient
was left in an extremely debilitated condition, with pulse 120 con-
tinuously, soft and fine — inability to assume semi-erect, or erect
posture — constipation, with frequent attacks of very severe pains
in the lower portion of the abdomen, which was occasionally very

Ramsey's Report. 153

much distended with wind. Opiates, mild purgatives, and demul-
cent injections, with generous diet, and tonics were used to destroy
this condition, but they failed to exert more than simply a mollify-
ing influence. The symptoms were finally wholly removed by
the discharge of a five months foetus, after which, under a contin-
uance of Porter, Iron, and animal teas, and essences, she rapidly
and perfectly recovered. During convalesence an ulcerative ac-
tion, which had formed a connection between the nostrils, was dis-
covered in the septum of the nose. It did not progress to any
great extent and ceased as the system approached nearer to its
wonted tone and vigor.

Pneumonias. — Female fatal. An old lady Rheumatic, general-
ly feeble and long subject to cough, probably froi J n Chronic Bron-
chitis. This attack was recurrent, she having but poorly recover-
ed from an attack quite severe, occurring during the month of No-
vember of last year. In addition she was exceedingly imprudent
as regards diet, but especially in her habit of unduly exerting her-
self, at a time when physical quiescence was particularly necessary.
She was under treatment from the third to the nineteenth inclu-
sive.

ale — fa tal. A negro man set. something more than forty;
addicted to drink. He was never known to require medicine for
sickness, prior to this attack. \\ hen about twenty, he attempted
suicide, by cutting his throat, and carried the unsightly cicatrix of
the wound to the day of his death. His voice habitually was but
little more than a whisper, and he was subjected to a. very slight
hack-like cough, which were ascribed to the injury done the tis-
sues, by the self inflicted wound. On the 20th he chilled, follow-
ed by fever. I saw him Wednesday, the 21st, something more
than twelve hours after the chill had occurred, at which time
his pulse beat 120 to the minute, and was remarkably fine — truly
thready; his respiration seemed to be unaffected, and he was ly-
ing with his head but slightly elevated; bowels regular; tongue
moist, and he complained of pain at a point below the right nipple.
Pneumonia was recognized, but owing to the apparent mildness
of the symptoms above detailed, but little attention was given to
the physical signs, which, however, at this period did not reveal
any particular intensity, or extent of the diseased action. The
treatment employed embraced Mercurials, Opium, Tart. Emetic,

1 34 Ramsey's Report.

and blistering. He presented, daily, every rational manifestation
of improvement, so that on Friday evening, the 23d, his skin was
moist, pulse 108, round and more full, and appetite developed.
But about 4 o'clock, A. M., Saturday, the 24th, his respiration,
which had just been unaffected, became suddenly very shoit, forc-
ing him 10 call for his shoulders and head to be elevated ; pain oc-
curred above the right nipple, resonance dull, expectoration which
before was but slight, and moderately frothy, now more free, yet
not copious, but very thick, and presenting the color of ashes,
tongue dry, thickly fured, and crisped at tips. A blister, covered
by a strong lye pouliice to expedite its impression, was placed over
this newly developed site of disease, and the Mercurial and Tart.
Emetic preparations were alternated at shorter intervals. At 7
P. M-, his pulse being round, full, and not compressable, and the
Orthopnoea undiminished, a vein was opened ; but the pulse became
more frequent, soft, and fine, under the flow of blood, and before
four ounces were abstracted, the orifice was closed. At 6 A. M.,
Sunday, the 25th, he was observed to be delirious, in a few mo-
ments had an involuntary discharge, replied to a question, became
listless, and his respiration grew rapidly shorter, until 9 A. M.,
when he died gasping. The suddenness of these violent manifes-
tations, the knowledge of his wife's disposition, and the negroe's
fondness for whiskey, led to the charge that she had given him li-
quor during the night, which she denied, admitting, however, that
she had given him a syrup, compounded of Hourhound and Ele-
campaign.

A post mortem examination being permitted, revealed the right
lung excessively weighty, presenting a surface of the hue of liver,
and on being cut into, a texture resembling to the eye, that of
the biliary gland, of a deep livid red, with greyish spots, at points
exuding a matter in color like ashes, and at the apex a soft ashy,
puss-like matter. The left lung collapsed very considerable, and
could be inflated, presenting a variegated, or marbled surface ; while
the right lung was wholly impervious — the tubular character being
perfectly destroyed. It was in fact most thoroughly hepatized
from the apex to the base, and very evidently suppuration had
commenced, and in places was more or less complete, as at the
apex of the lung.

The case has been thus extensively transcribed from my note

Ramsey's Report. 1 55

book, because in the opinion of the reporter, it presents occasion to
bring forward some important and interesting points, — which can
not too frequently be passed in review.

A stout negro man who has Jived for more than forty years with-
out the necessity of a single dose of medicine, except probably, an
occasional dose of Epsom Salts, which he said he had taken when
he became costive, after laboring as usual during the day, and in
ordinary health, is suddenly taken with a chill, about 6 o'clock, P.
M., Wednesday, presents no positive evidences of very great in-
tensity of diseased action, and the force of manifestations seeming-
ly decline, under the impression of remedial reagents ; and then
bursts forth with an acquired vigor, terminating life within six
hours from the time of this new development, and within ninety
hours from the time of the first observed evidence of loss of health
— a suddenness of result which, though occurring with sufficient
frequency, to put the practitioner on his guard, is notwithstanding,
none the less astounding in individual cases, and furnishes to the
sensitive mind, occasion for specific investigation and reflection.

It be may that this was a case of latent inflammatory action, and
the diseased manifestations during the ninety houis, were only the
flickering life-eflorts of expiring nature; but I am disposed to re-
gard it as a case in which the diseased action commenced, and
with rapidity produced its effects, so that engorgement, hepatiza-
tion, and suppuration — and especially the last two conditions — ex-
existed in different portions of the lungs, at the same time. La-
tent Pneumonia, I presume can not exist, and the subject — as did
this one — be in the discharge of daily duties, seemingly in unusual
health ; the latency I suppose to depend on the predominance of
evidence of the disease given off by other parts of the organism, as
the occurrence of collections of matter, and of hepatizations in cir-
cumscribed portions of lung, which are revealed by examination,
in persons who have died from wounds, whether the result of vio-
lence, or the benign efforts of the surgeon ; or the very forcible ev-
idences of disease given off by the nervous system of children, in
cases which post mortem investigation prove terminated fatally
from insidious inflammation of the lungs.

Again. The most extensive observers — to whom we all must
apply for instruction — inform us that Pneumonia occasionally runs
its course with, as it were, lightning quickness, destroying life

1 56 Ramsey's Report

within twenty-four hours, acd without having given origin to any
very positive symptoms of intensity. In estimating the probable
severity of an attack, all teachers impress the value of the state of
the pulse, and the increased frequency and difficulty of respiration
—but we occasionally are warned not to rely solely on these. For
instance Dr, Williams— than whom there is no better authority —
says: "If the disease be extensive, and the function of the lung
much infringed on, the energy and respiratory movements will be
increased." Again — "the severity of the chief symptoms which
indicate the state of the vital functions, especially the dyspnoea, the
pulse, &c, must be taken into account in estimating the prognosis
in particular cases." And in expressing his views of treatment,
he introduces the "state of the breathing" as a criterion. But he
tells us that though dyspnoea and a small quick pulse "when pres-
ent positively indicate danger, their absence does not always re-
present safety, for most extensive and serious disease may exist and
these symptoms not be observed." And from Basse, the distin-
guished pathologist of Leipsic, we learn that, "Drunkards are pro-
portionately most prone to the disease, and what is remarkable it
scarcely manifests itself in them by the usual vital symptoms, al-
though spreading and advancing to the last stage ivith astonish-
ing rapidity."

The case, it is believed, impresses some important lessons which,
though by no means new, are none the less valuable. The liabili-
ty of Pneumonic inflammation under some circumstances to progress
with fearful rapidity, and the necessity of prompt, proper treat-
ment; the insufficiency of rational symptoms simply, to convey
an apprehension of the exact condition of the patient, and the es-
sential necessity of a knowledge to some extent, of auscultation
and percussion, without which the practitioner can not safely direct
the application of remedial agents.

Bum. — A very fat child, at the breast and teething. In an ef-
fort to walk, fell against the andiron which was hot. The acci-
dent occurred several weeks before I was called, and the burnt sur-
face was originally, as I am told, of but little extent. But it has
been constantly spreading under the impression of a great variety
of applications, suggested by visiting neighbors. At the time of my
first visit, the child's bowels were regular, surface by no means too
warm, pulse seemingly natural, child indisposed to take any food

Ramsey's Report. 157

except that furnished by the mother's breast, very fretful when the
dressing was disturbed, but at other times either sleeping, or lyino-
quiet in its cradle amused with the ordinary occurrences of the
room. On examination I found the sore to be superficial, but ex-
tensive, embracing the ear, cheek, neck and throat of the left side.
It was suppurating and very red and irritable. A moderately
warm starch and milk poultice was applied for a few hours, until
the redness and irritability were modified, after which cotton dres-
sings were used. For a few days the evidences of improvement
were observed, in the destruction of erythema of the injured skin,
the lessening of the suppuration, and the healing action at the
edges, when the sore suddenly assumed a dark appearance at a
point just below the chin, in a duplicature caused by the fat state
of the neck, and from which proceeded a thin discharge having a
very bad odor. In fact gangrene had commenced, but it did not
extend to any considerable portion of the surface up to the death
of the child, which occurred within forty-eight hours from the time
decided bad symptoms were first observed. During the day on
which, but before the discoloration was discovered, the child moan-
ed constantly, and uniformly vomited after nursing, its bowels fre-
quently moved, discharges small, pulse rapid, features sharpened,
the whole surface much too cool, and these symptoms continued to
increase in intensity until they terminated in the death of the child.
Suppression of urine prevailed for twelve hours preceding death.

The mother was excessively alarmed and apprehensive during
the first six days of her child's illness. She had two other children
to die, as I am informed, with, in most particulars, the same symp-
toms,— especially the vomiting after nursing,— she, during their
sickness, being extremely apprehensive and depressed.

I am firmly persuaded that death resulted from the mother's
milk, depraved by the very excessive and depressing apprehen-
sion, under which she labored, nursing the child during the last
week of its life. No symptoms of the internal organs being in-
volved presented prior to forty-eight hours preceding death, and
the first of these was vomiting immediately after nursing, and
these accompanied with depression. Too great a length of time
had elepsed from the reception of the injury, even had it been of
sufficient extent to be followed by such an effect, to ascribe the
death to collapse and nervous shock from the suddenness or extent

158 . Ramsay 9 s Report.

of the burn. And the irritation produced by the injudicious appli
cations made before my visit, had been measurably subdued, or
very much softened, before any unpleasant symptoms were observ-
ed. Yet the mother labored under great anxiety,— and suddenly
the child begun vomiting after nursing, the effort ceasing so soon
as the larger portion of the milk swallowed was rejected from the
stomach; and and then after a time, this symptom is followed by
frequent small discharges from the bowels, physical depression,

and soon, death.

Cases are recorded of children in apparent good health taking
the breast soon after the mother had been subjected to violent emo-
tion, immediately rejecting the milk, and dying suddenly— almost
instantly. But it is unnecessary to introduce these now; suffi-
cient has been stated by systematic writers which bears on the sub -
ject. Eberle says : " Women of very nervous habit and an irrita-
table temper are peculiarly liable to those mental perturbations
which are apt to deteriorate this nutrient secretion, (milk)." And
then quotes from Dr. Shrove— "Those mothers who are so unfor-
tunately situated that they can not avoid provocation, grief, or sor-
row, as well as others who possess an irascible and bilious tem-
perament, or are subject to great nervous debility, accompanied by
great susceptibility of every stimulus, will confer no benefits on their
children by presenting them with a corrupted milk, which can not
fail to injure their health, and lay the foundation of fatal maladies."
And that extensive observer and judicious compiler, (Church well,)
tells us that "great mental emotion, such as grief for the loss ot re-
latives, or dear friends, anxiety and worry from domestic trials or
great public calamities, have an injurious effect upon the milk, and
may seriously injure the child, although the mother's health may
not apparently suffer."

Ramsey's Report.

159

FEBRUARY, 1852.

Diseases.

Conc'sion of brain.
Tonsilitis,
Croupy Catarrh,
Bronchitis,
Pneumonia,

do
Ephemera,
Rheumatism,
Jaundice,
Erysipelas of Leg,
Constipation,
Colic,
Diarrhoea,
Cholera Morbus,
Spinal 1 rritation.
Gland. Torpidity,
Otorrhea,
Scrofulous O p -

thalmia.
Nasal Polypus,
Teething,

Bealed Breast,
Gestation,
Threatened Abor.,
Parturition,
Albuminaria,
Measles.

under 15

15 to 35

ovei

■ 35

V.'

To-
tal.

un.15

DEATHS.

15 to 35

ov.35

tal

Of this total, five reside in the country, one in town temporarily. Add
10 not in the table of this, because enumerated last month, but under treat-
ment during a portion of February, the total will be 48.

Pneumonia. — In the treatment of Pneumonia, Mercurials are
relied on, for the most part. Individual observation by no means fa-
vors the efficiency of Tart. Emetic in tolerant doses, and I wish
most respectfully to enter my humble remonstrance against its use
in this manner, as a remedial agent. The admitted fact that a
proportion of practitioners adopt opinions and practice from an ex-
tent of reading, so limited as to be insufficient to furnish observa-
tions and opinions for comparisons and contrasts, which are the
necessary data for ratiocination, constitutes a reason why attention
should be repeatedly called to the action of particular medicines.

There are practitioners who have their specifics, in which they
place confidence, upon the assertion and specious argumentation

160 Ramsey's Report.

of others, not deeming themselves responsible if the article fails to
meet the exigency which demanded its application. And unhap-
pily, there are too many practitions who regard Tart. Emetic as the
only engine which can be directed against Pneumonia, with hope
of success, because forsooth, high authority commends its employ-
ment; and if in treating this disease they are unwarily ousted, they
remain content, without for a moment enquiring whether their own
agent had not given aid to the enemy. It is not denied that Tart.
Emetic, under the discretion of a practitioner who fully recognises
the power of the agent, may occasionally be employed to the pro-
duction of markedly beneficial effects ; but it is believed that its
use is dangerously uniform. So too, without doubt, Digitalis, may
occasionally be used in the treatment of Pneumonia with happy
effect. And probably, the Veratum Viridi, to which recently, con-
siderable attention has been given, may now and then be advanta-
geously employed — all producing results after the same manner.
This latter agent I have never seen used, but drawing my conclu-
sions, principally from the papers of its champions, I class it with
Digitalis and Tart. Emetic in its mode of action in inflammation of
the lungs, — but regard it as vastly more hazardous.

Digitalis is admitted, by all observers, to exert its influonce in
Pneumonia, and other inflammatory diseases indirectly, none at
the present day claiming for it any character as a direct antiphlo-
gistic agent. And while the assimilated influence of Digitalis and
Tart. Emetic, on the heart, is universally recognised, the latter be-
yond the tormer, has acquired a place of confidence as an anti-in-
flammatory agent. This in some measure it justly merits, but not
to the extent which gives it precedence to other agents, which are
known and read of all men, as worthy of continued confidence.

In tolerant doses, or in long, continued and frequently repeated
small doses, Tart. Emetic directly impresses the heart, depressing
its^ower of responding to the stimulus, and thus weakens the force
of the circulating current. It thus, indirectly, exerts an influence
by withholding from the diseased tissues, the blood which is, in-
deed, the pabulum of inflammatory action, and not by any particu-
lar change, which it directly induces in the affected tissues, or in
the essential condition of the diseased action. But while it is ad-
mitted that the blood is necessary to inflammatory action, and that
it will be modified in some measure by the modification of the

Ramsey 's Report. 161

force and quantity of the blood with which it is furnished, the re-
quirements of the whole system, and the conditions constituting
obstacles in satisfying those requirements must not be forgotten, or
overlooked.

In all conditions, every portion of the economy demands proper-
ly prepared blood. Blood is the natural stimulant of the heart.
iThe heart requires nervous influence with some degree of integri-
ty, and the nervous system must have blood with some degree of
life-supporting energy. But in Pneumonia the lungs are in a
condition, which, to a greater or less extent, prevents the consum-
mation of the last stage of the elaborating process, by which the
blood is fitted for its purposes in the economy. Ic is prevented
from receiving the amount of air necessary to its complete refine-
ment, and bearing some relation to the incompleteness of re-
finement, is the increased effort of the heart to comply with the de.
mands of the general system for pure blood. This effect is observ-
ed pre-eminently in anemia, and though the condition of the blood
is different in Pneumonia, the alternate results from its impression
on the heart are the same — quickened, but weakened action and fi-
nally complete exhaustion. And bearing a relation to the depri-
vation of the blood from oxygen, is the loss of integrity on the part
of the nervous system, until it is wholly gone, and in whatever
degree it may exist, of course must be unpleasantly participated in
by the heart. Now add to these in Pneumonia, intrinsically de-
pressing influences, the impression of an artificial agent, which
directly affects the effort of the heart, and depresses its power,weak-
ens its force and destroys, or obtunds its sensitiveness to the impres-
sion made by its own natural stimulus — add the influence of such
an agent as Tart. Emetic in tolerant doses, and it seems to me that
most efficient aid will be given to an attack which has invaded the
very source of vital manifestations.

But it is true that the energy of Mercury — the great modifier of
inflammatory action — is many times sorely tried in Pneumonia,
and hence the necessity of a co-adjuvant energy being made to
play by the physician. Heretofore, blood-letting, blistering, and
Tart. Emetic have been relied on, — all good under the direction of
discerning practitioners, but as liable to produce bad as good ef-
fects, if applied without regard to particular and general consider-
ations. But these are sometimes inadequate to the subjugation of

1 62 Ramsey's Report.

the disease, in cases otherwise solvable. Indeed, so very confident
is the almost universal reliance on these, that probably other most
efficient agents, are neglected, Of this fact I am the more convinc-
ed from having used most pleasantly an agent which is not refer-
red to at all in the large number of systematic works of Practice,
Wood alona noticing it, and he with remarkable cursoriness. Af-
ter a lengthy and judicious consideratiDn of the treatment, he says,
"other remidies which have been used with asserted benefit are
***** Iodide of Potassium in the advanced stages, when
the lungs remain consolidated, and all Fever has disappeared."
At another time I may institute an enquiry as to the legitimacy of
the conditions laid down by the respected savant in the profession ;
my only intention at present, is to attempt to attract more atten-
tion to the article, by adding my own, to the assertion of others,
that it has been beneficially used in Pneumonia.

I think it was during the year '45, that a young girl aged about
14, was attacked with most violent Pneumonia. She belonged to
a family eminently scrofulous, — but had herself usually enjoyed
health. The attack was promptly met ; the pneumonic armament
being exhausted, but without the effect which was desired being
attained. She had been ptyalised for several days, and yet or-
thopnoae persisted, and in truth the case seemed hopeless. The
idea of the scrofulous element probably constituting the continuing
cause of the diseased action was presented to my mind, and the
administration of Iodide of Potassium was resolved upon, and im-
mediately commenced. Whether the etio-pathological view was
correct or not, the conclusion to which it led, was soon rapidly pro-
ven. The patient rapidly regained a state of composure, to which
she had been for some time a stranger; the difficulty of breathing
subsided ; the rusty sputa disappeared, and by the assistance of a
psoper tonic regimen she attained her wonted health.

Since then I have, as occasion seemed to require or admit, used
the Iodide of Potass., and in every case with such results as seem-
ed to me, undeniably beneficial. With a single exception every
one, with whom it was used, recovered; and in the case constitu-
ting the exception, imprudence conjoined with a system very much
shattered, by previous disease, and old age, wholly thwarted the
efforts of my best judgment. But never, until recently, have I had
an opportunity to employ the agent without conjoint treatment, —

Ramsey's Report. 163

thus proving most positively its efficiency, or the total inutility of
remedial recourse, by the spontaneous, though coincident reduction
of Pneumonic inflammation. This occurred in the cases noted in
the tables.

The first was a female, aged 75, of fine physical endowments,
active habits, and rather irritable under sickness. During her life
she has frequently been seriously ill, and has endured much hard-
ship, has reared a large family, and has had occasion for great men-
tal anxiety. She was attacked by Pneumonia, which was treated
with Calomel and Camphor and blistering. She recovered. Two
weeks after her leaving bed, but before she had ventured from
her room, she very imprudently exposed herself for half an hour
at a raised window, directing some gardening operations. Within
five hours, she chilled, had fever, stitches of pain in the right side,
very slight cough, rusty sputa, dullness on percussion, and loss of
respiratory sound, to a limited extent, over the lower portion of
the right lung in front ; respiration unaffected, except a deep, long
breath produced tolerably severe pain; cheek very slightly red;
pulse eighty. Under the circumstances, hot poultices of bitter
herbs were ordered, and continued though the day and night —
treatment commenced about dark. At 3 o'clock the next morn-
ing — some nine hours after the application of the first poultice,-—
she was sweating, but the stiches of pain had increased in fre-
quency and severity. Five grains of Iodide of Potassium w r ere
given in syrup. This dose was continued every four hours for
nearly thirty-six hours, when it was discontinued, the spit having
lost its rusty character, the cough being wholly allayed, and the
patient feeling herself well. It must be remarked that after the ad-
ministration of the first dose, no pain whatever was experienced.

The apparent promptness of the effect following the impression
of the agent in this case, was mentioned to my associate in practice,
to whom I related the general features of several other cases in
which I had used Iodide, to the production, seemingly, of very de-
cided beneficial results. A few days afterwards he was called to
the second case of Pneumonia, enumerated in the table. A yellow
girl, set. about 21, mother of two children, very thin person, small
frame, and evidently predisposed to to Phthisis. Some weeks ago
she continued her occupation, as washerwoman, during a profuse,
but, otherwise, natural menstrual flow, which was suddenly stop-

1 64 Ramsey's Report.

ped. Since then, she has been gradually growing weak. Four
days before he saw her, she had a chill, after which she was
confined to bed, perfectly prostrated, but without pain, and very lit-
tle if any cough. She had been taking pills, presumed to be aloe-
tic, every morning; and at night, pills presumed to be Opium.

Her pulse was 80, and very fine ; respiration exacerbated ; per-
fect deadness on percussion, over the whole of right lung, before
and behind ; inspiration not heard at all, and expiration very slight
at apex, and much prolonged; sound of heart heard all over the
right lung. Vesicular respiration very strong and loud throughout
left lung. Altogether evidencing almost perfect solidity of the
right lung. Indeed, so great was the degree of prostration, so very
attenuated the frame, and extensive the result of diseased action
in the lung that he almost despaired of being able at all to advan-
tage the patient. He ordered the Iodide in five grain doses in syr-
up, every eight hours. On seeing her the next morning — twenty-
four hours after treatment commenced, and four doses of the
medicine having been administered — he found her improved. At
the apex of the affected lung, inspiration and expiration very dis-
tinct, the expiratory sound, yet too prolonged; Jess dullness on
percussion generally, but more particularly about the scapula; in
short, the unpleasant physical signs much less intense, so much so,
that Dr. Mcintosh did not remember to have seen, during two
years residence in the Alms House at Philadelphia, so positive a
beneficial change in any pneumonic patient within so short a pe-
riod. The treatment was continued, with the addition of an occa-
sional Blue pill, and proper tonics, until the patient was discharged
well.

Mbuminaria. — iEt. 38. Broken constitution from early excess
in animal indulgences, and from the impression of Mercury and
•the affection for which it was especially employed. Became an-
ascuo before I saw him professionally. Urine highly albuminous,
frothy, and the froth persistent on being shaken, almost wholly
destitute of smell, pale, and the coagulum occupying one-third or
more of the test tube Sp. gr. 10. He was under observation from
the first of January. Pemedies, seemingly, modified the anasarca,
but of this I am doubtful — they certainly were of no radical bene-
fit. He became suddenly comatose, and died in a few hours after.

Ramsey's Report.

165

MARCH,

1S52.

DEATHS.

F)l900SP^

£?( under 15

15to35 ovei

■35

To-

un.15

15 to 35

Dver 35

To-

J—/ lk,vaOvO*

ivl 1 F

M | F i M

tal.

M iF

tal.

Psoriasis,

Herpes,

Measles,
do

av
b

Fever, Intermit.,

Constipation,

Scrofula,

Caries of Spine,

Colic,

Jaundice,

Nervous Exhaust.,

Convulsions,

]

Catarrh,

}.'

Croupy Catarrh.,

Bronchitis Acute,

Pn eumonia,

Ulceration Throat

Chronic Hepatiza.,

Erysipelas,

Enlarged Spleen,

Irritabil. Stomach.

Diarrhoea,

}•

Accidents,

Anemia,

};

Dysmenorrhea,

Gestation,

Threat. Abortion,

Ulceration Cervix

A\ r

Parturition,

Blenorrhagia,

1
12

Add remaining under treatment,

Of this total two are temporarily in to

* — - —

wn, four reside in the country.

Psoriasis. — A very interesting case of nine years' persis-
tence, invading the cheek, forehead, a portion of the scalp,
neck, breast, and arms; and occurring in a system predis-
posed to consumption, though without any evidences of the
predisposition being at all, even the least active. Muscu-
lar Rheumatism, very slight soreness of the throat, and habi-
tual constipation. Menstrual function unaffected. The

166 Ramsey ] s Report.

nitro muriatic acid pedilarium, nitro-muriatic acid linament
over the region of the liver to the production of pustules,
and five drops nitro-muriatic acid in sweetened water three
times a day, was the prescription employed, until the bowels
became soluble, and regularly acting once every twenty-
four hours. Under this, every symptom seemed to be soft-
ened, and particularly the skin affection evidently disap-
peared rapidly. So soon as this condition of the bowels was
decisive, she was put upon Cod-liver oil, half ounce twice
daily, with ten grain doses of Phosphate of Lime. Up to
the time of compiling this report the patient has increased
in flesh and strength, spirits very much improved, and the
Psoriasis almost wholly gone. At present there is room to
doubt whether the change of temperature, natural to the
change of seasons, has not had much to do with the disap-
pearance of the Psoriasis, as well as with the improve-
ment of the general health; but it can not be denied that
very great advantage has been derived from the therapeuti-
cal measures which have been employed. The case is yet
under observation, and will be referred to in a subsequent
report.

Herpes. — Located on the thigh and scrotum, and has nev-
er been healed, but has been active for five years. Iodine
internally, with a very weak ointment of Corrosive Subli-
mate, produced a speedy resolution of the diseased action,
and a positive disappearance of its evidence.

Measles. — This exanthemeta was introduced into town
from off one of the steamboats. The first case of which I
have any knowledge, and I presume the first occurring here,
'was the single one recorded last month. The boat landed
at our wharf on the 20th of February, and the measles ap-
peared on the child, who came off the boat, on the 22nd.
Soon after, it passed, under other professional charge,
through another family, who were passengers on the same
boat ; and four of the nine cases here noted, occurred in a
family which had been subjected to the same source of con-
tagion. On making enquiry, the fart of measles having ex-
istence on the boat, within more than two months preceed-

Ramsey 's Report. 167

ing the date of its arrival here, could not be established.
The first case was in contact with children in the eastern
portion of the town ; — the children of the first family, refer-
red to in the notes, were members of a school in the west
end of the town, though residing themselves in the northern
portion ; — the children of the second family, and whose
cases are noted in the table, resided in the centre of the town,
and were members of a school numbering some ninety pu-
pils, who resided in different parts of the town. The re-
maining five cases of the table were in families which were
represented in some one of the schools, or had been in con-
tact with the poison from the case of last month. The in-
iatory symptoms were not excessively severe, except, they
were accompanied with a soreness and enlargement of the
glands of the throat, which in every one of these cases, with
a single exception, occasioned more or less difficulty, until
the appearance with considerable copiousness of the erup-
tion, when it mitigated and gradually disappeared, with the
progress of the disease until terminated. For the most part
the treatment was restricted diet, tepid drinks, and occa-
sional opiates,' with astringent, and sometimes acidulated
gargles, and when necessary Castor-oil. But some of the
cases demanded more positive measures. One of the earli-
est occurring — a male aet. about 4 — had difficult breathing
and the physical signs of pneumonic engorgement. These
were promptly allayed by a strong lye poultice made to en-
velop the whole chest, and Iodide of Potass, in two grain
doses, every five hours. Three other cases occurring later
in the month, females set, 14, and one aet. 8, were more seri-
ously affected; the pneumonic inflammation having progress-
ed with more rapidity, and the general symptoms being
more active, Calomel, a relatively large dose, with Ipecac,
was given, and after a time, the Iodide of Potass was com-
menced and continued, with very decided benefit. The reg-
ular course of the disease was not interfered with in either
case, the eruption continuing during six days, successively
involving the face, body, and extremities. In some cases it

1 68 Ramsey's Report

remained indistinct on the face, for forty-eight to seventy-
two hours, when it thickly, and at the same time, appeared
on the face, body and arms. But in these cases it was hard-
ly discoverable after the sixth day. In two of the cases, con-
valescence was slow, the system being asthenic, and re-
markably prostrated, without cough, or derangement of the
bowels, the positive evidences being absence of appetite,
and very decided indisposition to muscular effort, however
slight. One of these cases was the male child in whom the
pneumonic complication, as has been noticed, presented, and
who perfectly recovered ; the other was a female aet. 7, who
had been "sickly" from her birth, and heretofore, had been
subjected to very extensive medication. She passed through
the measles, without any difficulty whatever, but being
then pale, in fact, anemic, she was first put on Liquor Oxy
— Sulphate of Iron, five gtts. three times a day, and soon
regained her appetite, and commenced her duties at school.
Her case will be noticed again, under the table of next
month. In all the cases, even systems of ordinary vigor,
appeared to demand the impression of a stimulus to start
them into wanted activity, after the disappearance of the
eruption, and two or three required Quinine, there being
very evident febrile tendencies at particular hours of each
succeeding day.

Nervous Exhaustion. — From excitement. Treated with
stimulating doses of Opium.

Dysmenorrhea. — Used with very positive advantage in
the treatment of this case a combination of Camphor, Qui-
nine and Belladonna.

Parturition. — Breech presentation. Girl child, remarka-
bly large, expulsion of head retarded, child asphyxiated, re-
vived after a protracted effort, but lived only some six hours.
Puerperium uncomplicated for more than seventy-two hours,
when frequent and painful micturition presented, some-
times in the course of the morning and again in the even-
ing, but ordinarily but once during twenty-four hours, and
lasting from one to four hours. The attack was truly pain-

Ramsey } s Report. 169

ful ; for more than a week this condition prevailed, va-
rious agents being applied without any success, Copaiva,
finally, seeming to be the efficient medicine — the liability
to an attack disappearing during the time of its use. I can
not conceive this symptom to have proceeded from "swel-
ling of the meatus urinarius," for its appearance was too
long delayed, the introduction of the catheter was unneces-
sary, the pain was too excessive, local applications were too
inefficient, and the condition too persistent. After its final
cessation the patient rapidly attained her wonted condition
of perfect health.

Threatened Abortion. — This case will be noticed again.

APRIL, 1852.

Diseases.

Measles,

Lichen Urticatus,

Zona,

Herpes Circinnat.,

Fever, Intermit.,

do
Ephemera,
Constipation,
Lead Colic,
Colic,

Cholera Morbus,
Dysentery,
Diarrhoea,

do
Nurs. sore mouth,
Croupy-caturrh,
Inflam. Tonsil,
Pneumonia secon.
Consumption,
Rheumatism,
Granular Opthalm
Scrofula,
Accidents,
Cephalalgia,
Convulsions,
Gestation,

do
Parturition,
Menorrhagia,
Axillary Abscess,
Secondary Syphil.,

under 15

15to35

over 35

To-
tal.

M F

w
b

1
1

w
b

1
1

b
w

2
1
]

■

1
1

} 3

2
1
1

lei

f trea

tment, il

DEATHS,

|un.l515to35

ov.25| To-
tal.

1 1

1 70 Ramsey *s Report.

Measles. — In several families in which some of the cases
here noted occurred, there were others, but so mild was the
attack in its outset, and so regular did it proceed in its
course, that professional advice was not considered to be
necessary, and I saw them only incidentally, and they are
therefore, not placed in the table. But another point is to
be remarked, in more families than one, numbering several
members, who had never had the Rubeola, a single case oc-
curred. In one family, indeed, in which there was some
six children, one was taken, who it was thought had passed
through an attack during early infancy, but of which there
is now some doubt, and no other member of the family had
the disease for more than a month afterwards, though they
were all liable. I have met with the review of a history of
an epidemic of Measles which occurred in some island of
the sea, under circumstances presenting peculiar advanta-
ges for observation. In this epidemic it was affirmed, that
the period of incubation was certainly fourteen days, the
poison lying dormant for ten or twelve days, the system
manifesting no disturbance whatever, when the catarrhal
symptoms commenced, and afterwards, and just fourteen
days from the time when the contagion was encountered,,
the eruption appeared. The fact just mentioned is suffi-
cient affirmation that nothing approaching regularity has
been observed here during this epidemic. In truth the ir-
regularity of the prevalence of the disease, in different fam-
ilies, — in one all sick, in another, but one, and in another
one or more, and the others escaping ; and yet in another,,
one or more, the others remaining unaffected for a greater
or less length of time, and then pass regularly through the
several stages of the exanthemata, this irregularity has been
observed by the non-professional citizens, and has elicited
remark. I am, therefore, forced to the conclusion, that the
author of the statement relative to the period of incubation
has wholly failed, in putting at rest, a question which he
considered as having never been satisfactorily settled, until
the publication of his observation ; — and further that the

Ramsey's Report, 171

period of incubation can not be said to be eight, ten, four-
teen, or sixteen days, or in short, any definite number of
days, or distinct length of time.

The same asthenic condition referred to under the table
of last month, prevails on the cases convalescing from Mea-
sles, during the month of April ; and the periodic exacerba-
tion of any of the symptoms of disease which remain or oc-
cur after the disappearance of the eruption is very evident.
The first case occurring during this month, was a male set.
about twenty months, teething, and who has been very
slightly affected with Diarrhoea. After the catarrhal symp-
toms had prevailed for more than seventy-two hours, pale
purple colored spots were with difficulty discovered on his
face, about the cheeks. This continued for full forty-eight
hours, when the eruption was completely developed over
the face, neck, body and arms, after which it passed through
its course, without any difficulty, the condition of the bow-
els requiring a little attention, and terminated, being hard-
ly discoverable the morning of the seventh day — counting
from the time when the purple spots were first seen. He
seemed very well, but weak, for some three days, slight stim-
ulants, and proper diet being furnished, w r hen he was ob-
served to be too much inclined to sleep. This was the first
departure from the progressive attainment of health. The
bowels, at this time, were laggard in action, rather than
too frequently discharged. The head was a little too warm,
the temper ordinarily very placid, was now very irritable.
He was easily aroused, but soon again went into a sleep,
which seemed to be sweetly composed, the breathing unaf-
fected, the lips red and soft, tongue by no means dry, skin
not [moist, but soft. This condition continued for two days,
during which, a few doses of Calomel and Ipecac were ad-
ministered, but under its operation there was no mitigation
of symptoms.^ Indeed, there was an increase in their inten-
sity, and another, of serious import, supervened — suppres-
sion of urine. But, consentaneous with the observation of
this symptom, was that of a morning mitigation, and evening

172 Ramsey 9 s Report.

exacerbation as evinced, more particularly, in the greater
softness of the skin, and the less disposition to sleep, daring
the earlier hours of the day, than during the afternoon and
evenings. He was immediately subjected to the impression
of Salicinc and Brandy, with diet at stated hours, under
which he rapidly and perfectly recovered. This certainly
was a case of Remittent Fever, and though occuring after
Measles, can not be said to have been caused by the impress
of the rubeolus poison. Another case, in which the period-
ic element was well marked, was in the person of a female
over thirty-five. The Measles had disappeared two days,
when she was attacked with chill, diarrhoea and excrucia-
ting pain of the abdomen, without circumscribed location.
These symptoms appeared once, and, sometimes twice, du-
ring twenty-four hours, for some four days. Opium and
poultices, were the agents at first employed, to which finally
Quinine was added, after its impression, the patient was
soon discharged— cured.

A male, set. about 7, had been in the eruptive stage some
forty hours, when he was attacked with convulsions. He
had two in the course of an hour, and before I reached him.
I found him with muscular twitchings, and a very rapid pulse
tongue very much coated, the redness of the surface suffi-
ciently intense, and eruption full and extensive. During the
morning, and some hours before the convulsive seizure, he
had passed by the mouth a worm. A large dose of Calo-
mel and Ipecac was administered ; the case progressed
without any further complication, and this one not interfer-
ing with the regular progress of the Measles, in no percep-
tible degree delaying convalesence.

A male, aet. about 3, passed through measles, with slight
intercurrent bronchial inflammation. Two days after the
disappearance of the eruption, very active febrile manifes-
tations were observed, which were soon followed by urti-
caria conferta. It continued for about forty-eight hours,
and seemed to be pleasantly affected, by drinks very weak-
ly acidulated.

Ramsey's Report. 1 73

Two females, one very irritable under the attack, and who
was very much affected with sore throat, the other, having
bronchitis, menstruated during the course of the eruption.
In neither case did the disease seem to be, in any way what-
ever, influenced.

Lichen Urticatus. — These three cases occurred in a sin-
gle family, two within two or three days of each other— both
being sick, when I was called — the third, a week after I
had discontinued my visits to his brothers. The symptoms
of an attack were those which usher in febrile attacks, —
chill, more or less severe, followed by fever very intense, so
far as the sensation imparted to the hand of the examiner
constitutes a criterion, pulse accelerated, but not full.
Sooner or later, minute red points appeared, resembling flea
bites, — but there was no abatement of the excessive heat of
the surface. The tongue was coated, appetite gone, and
bowels constipated. Saline purges were employed. The
cases terminated, irregularly, from two to five days after I
saw them. The eruption invaded the face, neck, back and
breasts; was itchy, and burning. By some authorities this
affection is said to be seldom encountered ; but in a popula-
tion, by no means dense, half a dozen cases have occurred
to me, within two years ; and I have heard of cases occur-
ring, in the same population, to other practitioners, which,
from the description, I have no doubt was the same affection.
I have, in previous tables, intimated that cases of this dis-
ease had been regarded as Scarlet Fever.

Zona. — A very old female, flabby, poorly fed and clothed,
asthmatic, and costive. Relieved in a few days of threat-
ning and unpleasant symptoms by purgatives and opiates,
conjoined with nauseants.

Herpes Circinnatus. — These cases occurred in pupils be-
longing to the Tennessee Deaf and Dumb school. The
itchiness preceding the appearance of the vesicles occa-
sioned very positive anoyance. There were, in all, more
than a dozen cases, but these only were placed on the vis-
iting list. Every patient, without exception, complained of

174 Ramsey's Report,

a heavy, uneasy sensation at the epigastrium, and was more
or less constipated. The disease is not regarded, by the
most reliable authorities, as contagious — dietic error being
considered its principal source — though it occasionally oc-
curs as something of an epidemic. No cases, however, have
presented in persons not members of the school. Alkaline
washes, and laxatives were employed. Most of the cases
recovered, some, however, will be numbered in other ta-
bles.

Fever Intermit. — One of the females very inconsiderably
jaundiced ; one, a member of the Deaf and Dumb school,
had Herpes. One of the adult males had Otorrhea. The
children were teething, and the black child had Diarrhoea.
They were all treated effectually, with Salicine* except the
case with Otorrhea, which required Quinine.

Constipation. — The elder female had very severe maxilla-
ry inflammation ; the bowels had not moved for several days.
After the impression of an active purge, the pain was allay-
ed, and inflammation rapidly reduced. The male, after
two doses of Jalap, remained tolerably well for a few days,
when he had obstinate Diarrhoea, which was finally check-
ed under the use of Blue pill and Opium.

Pneumonia Intercurrent. — A young girl in very destitute
circumstances, set. 20, never menstruated, anemic. Had
been laying with Measles, without any professional direc-
tion, for two weeks. Her bed was just beside the door, and
she received the impression of every blast of wind from the
south, and directly off the river. I was called to her forty-
eight hours before death, found her with frequent serous dis-
charges,which were passed involuntarily, tongue dry, black,
and pointed, and protruded, with the greatest difficulty, even
to a slight extent; teeth covered with sordes; respiration
very short, quick, and rattling; lungs hepatized, except at
apex; throat sore 3 and stupor, at most times profound ; abdo-
men tympany. Blisters, stimulants, and Hyd. Potass were
employed, but they, seemingly, made no impression

Rheumatism. — This case was illustrative of three very

Ramsey* s Report. 175

important points. The foolishness of reposing confidence
in persons, wholly unfit by nature, or education, to investi-
gate the abstruse study of disease. The error of local ap-
plications to the parts affected by the Rheumatic element.
The value of full doses of Opium in the treatment of Rheu-
matic inflamation.

The patient complained of pain and swelling of one joint,
and being exceedingly anxious to prosecute his business, ex-
pressed his great desire to be well, in the presence of "a
new kind" of doctor, who is operating here. He strongly
asserted that, he could produce a cure in less than twenty-
four hours, and obtained the consent of the patient to a trial.
A very powerful liniment of Turpentine and other agents
was applied to the affected joint. In less than twenty-
four hours, instead of being well, other joints were affect-
ed ; and these in turn received, liberally, the was to be car-
minative liniment. For two weeks or more, this applica-
tion was employed, until, finally, the positive declarations,
daily made by the "new kind of doctor," lost their effect, and
the patient's condition alone influenced him. At this pefiod
we visited him, and found every joint of his body more or
less affected ; his ancles, knees, wrists, fingers, shoulders and
spinal column — in fact every joint, with probably the hip
excepted. In addition, the peculiar rasping sound of the
heart, which indicates the involvement of that organ in the
Rheumatic action, was present. Mercurials were used in
connection with Opium, for forty-eight hours, with very de-
cided advantage. At this period he was put on the use of
Scudamore's mixture, which was discontinued after forty-
eight hours, because the symptoms were evidently exacer-
bating. Dover's powders, with an addition of Opium, was
given every hour, until nausea was produced, after which,
Opium alone was administered just often enough to keep
him free from pain. At first every two, after a time every
four, and subsequently every eight, and twelve hours, — as
the symptoms mitigated, increasing the interval between the
periods for the administration of the medicine. He was under

176 Ramsey's Report.

charge twenty-two days, and was discharged almost wholly
free from any symptom of the disease. He has since oc-
casionally visited the office, complaining of some transient
pain or stiffness, which is readily allayed by a dose of Opium.
In his case, one or two doses of the drug produces an exces-
sive and universal itching of the skin, an effect which, has
occasionally been observed to proceed from Opium.

In reading reports of cases we very frequently see remarks
expressing astonishment that, notwithstanding, the fact that
Opium entered largely info the prescriptions, the patient's
bowels were regularly or even freely moved. Now it is a
fact, that has been frequently observed, and should be known
to every one who presumes to use the agent, that a person,
under the influence of Opium, will be more easily affected
by purgative agents, if indeed his bowels should require
their application, than they would, were he not influenced
by the soothing, relaxing, quieting impression of this narco-
tic. This was illustrated in the case we are reporting — du-
ring the twenty days, after the use of the Mercurial, three
or four small doses of Castor Oil and Oil of Turpentine were
required, and administered.

Parturition.—One of these cases, the elder, had borne sev-
eral children, once twins. This labor commenced with a
very severe chill, or shake accompanied by a cold sensation,
and which continued for about three hours and a half, or
until the termination of the labor. The pains were frequent
and severe for the last hour ; the progress of the labor much
more rapid than any ever observed by me ; the puerperium
was uninterruptedly happy.

RECAPITULATION.

January,
February,
March,
April,

SICK.

DEATHS

underl5jl5to35

over35

1 To-

un.15

15to35

ov.35

Total

F / M

|tal.

M F

15
1

24
2

2
1

1 4

2
1

4
1

10
2

35
3

5
2

9
1

1 —

231

(

ECLECTIC AND SUMMAEY.

The Slandering Quack, by Laseus Medicus.
cr Disisli pisin, — te vomans vill tie if he takes tem in te pelly.' ;
Dr. Dixon : — Permit me to direct your attention to the
Slandering Quack ; a variety of that interesting species of
the genus, which, I believe, has not had its characteristics
exposed to public view, by means of the Scalpel ; and which
has, within a few years, increased to a fearful extent in this
city. The individuals of this description who may now be
said to form a part of that heterogenous compound, called
the "Medical Faculty of New York," have their origin, for
the most part, from the scum of ignorance and depravity,
which abounds in some of the densely populated countries
of Europe, where, no doubt, many of them graduated in the
shops of village apothecaries, or the culinary departments
of the great hospitals. But no sooner have they entered
the Paradise of Humbugs, than they become, by the aid of
a vast amount of brass, a little tin, and a few ounces of paint,
learned "surgeons and physicians." And when one of thern
is sent by some gossip from "fatherland," or the "land of
fogs," to see the patient of a respectable practitioner, he ex-
amines the medicines prescribed, without the slightest re-,
gard to common courtesy, shakes his head and shrugs his
shoulders most ominously, and then gravely pronounces
sentence in broken English, for the benefit of the neighbors :
"Dis ish pisin, — te vomans vill tie if he takes tem in te pel-
ly ;" or, if he be the friend of frogs and revolutions, "bah !
zat Doctare Amerique give de pashen von, shree, fore doze
de Mercure, vat make de mort."

The attending physician is forthwith discharged. The
"new doctor" prescribes bags of "toasted oats," or some oth-
er equally potent remedy; "wisely keeps for show" a por-
tion of the deadly poison, which he pretends to analyze.
Then his profound erudition is lauded, and his fame spread
far and near by his countrymen. And soon the important
air, the twirling cane, and the massive gold chain, proclaim to
the astonished natives, how fortunate he has been in finding
such an easy stepping stone to "success in the profession."
— Scalpel,

Truly, the Scalpel's correspondent draws a picture well,

178 Eclectic and Summary.

but the original is not confined to the city of New York.
The following exhibition of acumen of skill and profundity
of knowledge, will no doubt arouse feelings of wonderment
if not of admiration. It is a printed card, (which we copy

verbatim et literatim?) and we are told the advertiser hands
it, in person, to every pale visaged individual with whom he
meets

DR. S. J. A. BURG, FROM SWEDEN.
Botanic Physician Reformer and Simplijier of Medical

Practice.

Offers his Service to persons laboring under any kind of
Chronic as well as acute deseases in any shape or form what-
ever.

Read the annexed Certificat from the Citizens of Warren
and Van Buren Counties, State of Tennessee :

"Wi, the undersigned, do hereby testify that Doctor Burg
has practised medicine in this vicinity since July last, and
that no death has occurred among his patients in our knowl-
edge, also that we never heard of any patients being re-
duced or made worse, and as far as wi know his patients
are generally doing well.

This 7th of January 1850.

Harmond York : Jesse Martin ; James Britt ; Erwin
Gribble ; W. B. Huddleston (Teacher in Burrett Col-
ledge, Spencer, Van Buren County) ; D. F. Wood, Mer-
chant ; J. M. Smallman.

No mercurial preparations used in any form or shape

Botanic medicine is only used and will do no harm in any
respect — no patient will be reduced — no particular diet
required — the patient may continue his daily occupations.
Only the medicine is taken according to direction and con-
tinued in — Good health will then be the consequence.

Why Suffer Longer then Sufferer when you have an ap-
portunity to get well and be restored to your family without
to be punished by reducing you. During the last four
years Dr. B. have attended to about 1000 patients and lost
only two by death, the following is the Counties in the State
of Tennessee, where he has practised viz Marion, Bledsoe,
White, Van Buren, Grundy, Coflee, Franklin and Cannon,
and in Kentucky, Allen, Warren, Simpson and Barren
Counties.

In consequence of his great success, he was reguested by
many to give instruction last year 1851 and 10 students
where discharged.

Eclectic and Summary. 179

For the benefit of Humanity he thinks it his duty to offer
his service to those who wish to learn his mode of practise.

Therefor he offers to receiv students and promise to learn
them the Clinical practise in a verry short time so they may
be able to practise.

As Dr. B:s mode of treating deseasesis different from the
regular practise and being most successful in his treatment
of all kinds of deseases this may be regarded as a verry fa-
vorable opportunity for those who desire to learn haw to
heal the sick.

All kind of deseases is attended to, but he will mention a
few of them, Dyspepsia in all the different forms, Scrofula,
Lever complaint, Consumption, Hysterics and Hypochondric
affections, Dropsj r , Asthma, Gravell, Piles, Fits, Rupture,
Lamnes, Cancers and Ulcers in every shape or form, Cholera
&c, Female, Deseases of every kind, Barrenes removed and
married Ladies who have ben without the blessing of hav-
ing Children have ben restored to health and obtained their
wishes as ill health is the couse of barrenes.

Dr. Burg wishes to awoid lawsuits and missunderstand-
ing with his patients, and therefore annex his bill of Charge.

Medicine furnished by him per week in cash $1,00

" " " on credit
— note on time. 61,25

Medicine when taken for 3 months at once cash $10,00

For a wisit of 2 mile or under each wisit $1,00

Every mile over and above said 2 mile each $0,25

Wisit during, or in the night dubbel charge.

It must be distinctly understood that he makes no con-
tracts for no cure no pay, all have to pay except those who
are poor and unable. Remember that if a patient has been
laboring under desease for a longtime that it takes some-
time before the desease can be thoroughly eradicated from
the System and unles that is don a permanent cure must not
be expected, therefore

Dr. B:s advise is to never commence unles the intend to
continue till the get well, wi loose both by it.

Dr. B. wishes to purchase sick negroslaves, no difference
what kind of desease the are laboring under neither the
time the have had it.

S. J. A. BURG, Botanic Physician,

February 1852. Walden's Ridge, Marion Co., Tenn.

180 Eclectic and Summary.

Poisonous effects of Laudanum, by Wm. P. Jones, M. D., of
Nashville, Tennessee.
About 10 o'clock on the night of the 27th of August, 1851,

I was called to see a patient 45 years of age, bilious tem-
perament, six feet high, full habit and in fine health ; who in
a state of intoxication had an hour before taken four ounces
of officinal laudanum. I found his pulse full, quick and
bounding ; his face flushed, eyes red and swollen, was but
little inclined to sleep, and evidently laboring under much
mental excitement, which in some degree at least, was at-
tributable to the cries and general distress of his family.

Immediately upon my arrival I attempted to administer an
active emetic, which, however, in a very determined man-
ner he resisted. After reasoning and persuasion had both
proven unavailing, and when several of his friends had come
in, I determined to take him and administer by force, the
necessary medicine ; whereupon he became exceedingly fu-
rious, and when his family heard of his demonstrations of
resistance, they begged me to refrain from any further at-
tempt of the kind, expressing the hope that they could in-
duce him to consent without resorting to the coercive meas-
ures, which I now proposed. Having in this peculiar case,
more regard for the feelings of the family than the life of the
patient, I probably violated professional duty in complying
with their request. Having procured a strong decoction of
tobacco leaves and directed its cautious, though if possible
copious application to his stomach and bowels, and succeed-
ed in giving him 3 ozs. wine of Ipecac, I left the room for a
few minutes. During my absence, his mental excitement
in some degree subsided, and drowsiness rapidly supervened,
until he was aroused by an effort at emesis. He threw up
but little, and that tinged with and smelling strongly of
Laudanum. Immediately after this effort, he fell back in
the bed and in a moment was in the profoundest stupor,
from which neither the frantic shrieks of his family nor the
thunders of heaven could arouse him.

His breathing suddenly became loud, slow and irregular,
his pulse though somewhat less frequent than before, had
still great volume and almost irresistible force. I now, at

II o'clock, sent every member of the family from the room,
drew him from the bed, stripped and placed him upon the
floor, and for an hour had constant recourse to the cold dash,
during which time respiration was becoming more and more
laborious and even difficult. Pulse irregular, and now
slightly reduced in volume and frequency. In the mean-

Eclectic and Summary. 181

time Dr. J. W. King, who had been sent for, came in, and
upon consultation, we continued the dash and resorted to the
the stomach pump. The pump being out of order, we had
but little difficulty in adopting a very efficient substitute,
[we introduced a gum-elastic tube and attached it to a two
pint syringe — this, by the way, constitutes the most sim-
ple, available, and convenient pumping apparatus we have
for the stomach;] with which we thouroughly washed his
stomach, bringing away a large quantity of Laudanum ;
still, however, no consciousness supervened. Dr. Buchan-
an was sent tor — examined the respiration, circulation, &c,
approved the treatment, made no suggestions, but thought
the patient would die in despite of our exertions. By this
time (12 o'clock) the muscles of the back, arms and legs had
become rigid — so rigid were those along the spinal column
that his head, which, when he was in a sitting posture, had
previously fallen upon the chest, or from side to side, now
maintained an erect position, and against the force of grav-
itation the rigidity of the muscles would still retain it. If
the legs remained flexed for a few minutes, they were with
difficulty extended, and if extended, not easily flexed. Re-
garding it indispensably necessary, we endeavored to keep
him constantly in motion ; still, his pulse and respiration
grew rapidly worse, until by leaving him quiet but a few
moments in the reclining posture, respiration would cease
entirely. After administering several copious enemas of
cold water, we, at 1 o'clock, suspended the cold dash, wiped
him off, threw into the stomach a glass of iced brandy toddy,
removed him to another room, placed his feet in warm wa-
ter, dressed him in flannel under-clothes, and commenced
artificial respiration. This, however, we had in some
measure adopted an hour previous to this time, by taking
hold of each of his hands and violently exerting the respira-
tory muscles. This mode of respiration having now proven
insufficient, we were compelled, in order to sustain life, to
keep up the action of the lungs, by the application of suffi-
cient force with both hands immediately over the dia-
phragm.

By thus laboring (from one to three minutes or more) and
creating a vacuum, respiration would be transiently estab-
lished, though rarely perpetuated for a longer period than
was necessary to reproduce it. After the first natural in-
voluntary inspiration, or, in other words, immediately suc-
ceeding the first independent inspiration, the pulse, which, by

182 Eclectic and Summary :

the mechanical effort was made lull and strong, would be-
gin to abate both in force and frequency, soon became im-
perceptible at the wrist ; but so soon as the air was pump-
ed into the lungs, the pulse would rise higher and higher
still, in proportion to the time the bellows force was exerted
over the region of the chest. And thus the patient remain-
ed, a mere stertorous machine in the hands of four or five
athletic men, for twelve hours ; for several hours of which
time^ to have neglected him thirty minutes would have seal-
ed his destiny.

At 3 o'clock, on the morning of the 28th, coma was most
complete, though at no time from 1 1 o'clock the night before
had there been the least manifestation of perception or
or wakefulness. The snoring which followed the mechan-
ical respiration, had been horribly loud all night, but now it
amounted to snorting. Rigidity of the muscles was more
general, pulse exceedingly small and irregular, whole ex*
ternal surface and particularly extremities, cold ; hands,
eyes, lips, cheeks and in fact the entire body, was livid.
Notwithstanding this combination of deathly indications, I
persevered in alternate contractions of the chest, as the only
possible means of his restoration.

At 8 o'clock, A. M., gave the patient, through the stom-
ach pump, probably a pint of ice water and brandy. Soon
after this, Dr. Winston came in, examined his general con-
dition, concurred as to the propriety of treatment, but thought
that it would prove unavailing — that he would die in an
hour. But life, which so frequently lingered at the lips, was
as often invited back ; and the pulse which so repeatedly
faltered, resumed its action at our bidding.

Twelve o'clock came, and no return of sensibility or con-
sciousness to the patient.

One o'clock, P. M. Artificial respiration was still kept up
in the same way and with like results. Presently, however,
he was heard to groan ; in a few moments thereafter his
eyes, hitherto fixed, were seen to move beneath the lid.
Again he sighed, and more deeply than before. Natural
respiration was gradually resumed. Circulation, became
more diffusive ; warmth returned to the extremities, and by
2 o'clock, P. M., he tried to speak, and finally remarked, he
had just about two hours ago taken four ounces of Lauda-
num, that he was getting sleepy and wanted to be let alone.

He recovered more speedily than could reasonably have
been expected. For many days he was of course very sore,

Eclectic and Summary. 183

indeed he could scarcely bear to be moved. His throat
from the rigidity of the muscles, and frequent introduction
of the gum-elastic tube, was so much inflamed that he could
swallow nothing else than warm fluids. His bowels re-
mained constipated for several days. Three drops of Cro-
ton (or to use his own expression. Telegraph) Oil, relieved
him of this, and in a week he was able to walk about the
room.

I will ask the Society the following

Question :

As in this, and other instances, artificial respiration has
resulted so favorably, may we not hope for better success
than has hitherto attended our practice, in this class of poi-
sons? as well as in cases of asphyxia not attended with or-
ganic lesion? — Nashville Med. and Sur. Journal.

Turpentine in Hemorrhages of Typhoid Fever, by Dr. Frank

A. Ramsey.

****** I have just finished reading "Extracts
from the Records of the Boston Society for Medical Im-
provement," published in the number for this month of the
American Journal of Medical Sciences. And I must confess
my astonishment that not one of the members — so far as is
shown by the "Extracts" — made reference to the spirit or oil
of Turpentine as an efficient remedy in the hemorrhages of
Typhoid Fever. If it is an omission on the part of the reporter,
he has not done justice to the members of the Society, But
if allusion to the applicability of Turpentine under the cir-
cumstances, was not made by any of the learned practition-
ers who were present during the discussion of the subject,
it must have been for one of two reasons. The claims of
Turpentine to remedial importance in the hemorrhages of
Typhoid Fever were not known ; or, if known, they had
been tested and found wanting.

I can not entartain the idea of a want of knowledge on this
point, on the part of those who engaged in the discussion ;
it would shock the feelings of respect which I have for Sto-
rer and others like him, and the love I have for the profes-
sion which has the time and talents of such men consecrated
to its improvement. But if they have found Turpentine to
be inefficient as a remedial agent, in the condition which is
evidenced by hemorrhage, they are certainly chargeable
with inexcusable neglect in not publishing the evidences es-

184 Eclectic and Summary.

tablishing the inefficiency ; for truly I have been under the
impression that it was esteemed, by the apt ones of the pro-
fession, as a styptic of very positive power, and peculiarly
adapted to the hemorrhages which occur during the progress
of an attack of Typhoid Fever. Upon this presumption I
have practised. I can not remember more than two cases
of hemorrhage from the bowels, presenting to me, as inci-
dent to Typhoid Fever. And I am also unable to say how
many discharges of a bloody nature either case had. Nei-
ther died.

One was a marked illustration of the very great depar-
ture from the natural condition of the solids and fluids of the
economy, which this fever is apt to occasion ; or which is
occasioned by the peculiar cause operating in this affec-
tion.

A hale, athletic man, aged about 40, very muscular, and
weighing, probably, 180 lbs., was attacked within a month
after settling on a farm in this county. He was from North
Carolina, There had been no sickness in his family for
some time previous to his leaving that state. There had
been no Typhoid Fever in the immediate vicinity of the farm
on which he settled in this county. There was, however, a
very great prevalence of the disease in town, two miles dis-
tant from his farm. No other member of his family was
affected. This was during the summer of 1545. He was
sick some three weeks, when he commenced getting better.
His pulse beat less frequently and more full and round ; his
tongue became gradually clean ; his bowels discharged not
oftener than once a day — a healthy, soft moulded passage ;
and his appetite was vigorous. Under these ci rcumstances
1 left him on Monday morning to attend a call thirty-five
miles distant. On my return the succeeding Saturday, I vis-
ited him, and found him bleeding from the gums, very
slightly tinging the saliva ; dark black oozing from his nos-
trils ; urinating blood ; ecchymosis under each eye ; every
discharge he had from his bowels, more or less bloody, and
he was reported to have had several "nothing but blood."
He was lying with his eyes half closed, muttering, only man-
ifesting intelligence on being called, by opening, for & mo-
ment his eyes, and when an arm was lifted, if let loose, it
would fall instantly, as though there was not even the least
muscular energy left. His was truly a desperate case — and
my then partner in practice, Dr. Wm. Rogers, who had
charge of him during my absence, ascribed the condition to

Eclectic and Summary. ■ 185

a teaspoonful of Castor Oil, which had been imprudently ad-
ministered by some member of the family on the previous
Wednesday. Under these circumstances, something more
than a mere astringent was demanded ; rhatany, kino, sul.
acid, all passed under review, but were set aside as not offer-
ing sufficient promptness and permanenc}'" of impression to
meet the exigency. Oil of Turpentine, in drachm doses
every six hours, was resolved upon, and, during the inter-
vals, beef-tea and Arrow-root jelly at stated periods and in
specified quantities, were to be given. In a few days we
had the pleasure of hearing our patient converse rationally,
and after a tediously-prolonged convalesence, he recovered,
and I have since seen him apparently and he says certainly,
as well as he was before the attack. This is but one case,
it is true, but to my mind it tells with an effect ten times
more forcible than the presumptions of even the most aged
and most experienced practitioners.

Some three years ago I had the good fortune to be thrown
in company with Dr. Ogleby, of Madison City, Georgia, and
in our conversation, he made reference to a case almost, if
not quite, as positive as the one I have so hurriedly given, in
its favorable testimony lo the virtues of Turpentine.

In the systematic works the importance of this article is
not set forth. Its virtues as a styptic were not well appre-
ciated in 1812, when the fourth American edition of Cul
len's Materia Medica was published. For Dr. Barton says,
in a note — "Though it may be difficult to explain the fact,
and improper to imitate the practice without great caution,
there can be no doubt, that the terebinthinate medicines
have sometimes been usefully exhibited in alarming bleed-
ings from the intestines and other parts of the bod}^. I have
myself seen good effects from the Turpentine in cases of
this kind. But it is chiefly the experience of respectable
British practitioners upon which I depend." Pereira makes
reference to it as a styptic in a careless, and by no means
commendatory, manner. But in the medical journals —
those very essential aids to correct ideas in medicine (the
physician, your correspondent of my state, who is so fear-
ful of leading young practitioners astray, to the contrary not- .
withstanding,) are to be found many reports from reputable
practitioners which tend to establish confidence in Turpen-
tine as a styptic. „

In the London Medical Times for December 14, 1850,
and November 22, 1851, are contributions from a practi-

186 Eclectic and Summary.

tioner by the name of Bradley, "illustrating the good effect
of Turpentine in hemorrhagic diseases." But communica-
tions more appropriate for citation under the circumstances
which have induced me to call your attention to this medi-
cine, are to be found in the Medical (Philad.) Recorder for
1826 and 1828. I hope that I will not be held amenable by
those infected by the rampant spirit of search after novelty
which is characteristic of the age, as well in medicine as
in almost every other department of human exertion, for re-
ferring them to journals published so long as twenty-four
and twenty-six years ago. Much has been proven to be
true which is seemingly forgotten, and an occasional turn-
ing up of "old documents" can not fail of producing good —
and the true and good, I take it, constitute the legitimate ob-
jects of the physician's efforts.

In the ninth volume (1826) of the Medical Recorder, is an
article taken from the Edinburgh Medical and Physical
Journal, October, 1825, to which it was communicated by
Dr. Magee, then senior physician to the Dublin Sick Poor
Institution, which, I think, bears on the subject of which I
am writing. The paper is entitled a "Case of Purpura Hse-
morrhagica, successfully treated with spirits of Turpentine."
Its author says he was induced to try the remedy in subse-
quent cases from its efficacy in checking the hemorrhage of
dysentery. He further says that, after this^case he had "sev-
eral cases of Purpura which did not assume the hemor-
rhagic form, solely, 1 am persuaded, from the use of the Tur-
pentine." This case is of importance, and, therefore, wor-
thy of perusal, whether the opinion of the writer as to the
mode of operation and manner of combination be adopted
or not.

But the most important cases bearing on this subject, are
cases 3d and 4th, recorded by Caleb B. Mathews, M. D., of
Philadelphia, in the Med. Recorder, Vol. XIV., 1828. Case
3, after "repeated attacks" of Intermittent Fever of the ter-
tian type, was suddenly seized with alarming hemorrhage
throughout the whole mucous membrane. A similar case
in the same family had a fatal issue, in which the Turpen-
tine had not been used. Twas employed in this case and re-
covery resulted. Case 4 was in the same family, and was
a case of hemorrhage after protracted Fever, cured by Tur-
pentine.

On the 118 page of Braithwaite's Retrospect, Vol. XX1L,
will be found a very interresting paper on the subject, by
Dr. Budd.

Eclectic and Summary. 187

If you think these remarks will in any way subserve the
purposes of that improvement which is the proposed object
of the Society whose deliberation induced me to write, you
are fully privileged to publish them in your very interesting
and valuable weekly. — Boston Med. and Sur. Journal.

Knoxville, Tenn., January 28, 1852.

NOTICES.

Proceedings of the twenty -third annual session of the Medical
Society of Tennessee, held at Murfreesborough, May, 1852.
JVashville Med. and Surg. Journal, July, 1852.
This is the Society which has chartered privileges and is pre-
sumed to have the interests of the protession of the whole state in
its keeping. At the organisation of this session, but fifteen mem-
bers were present representing three counties ; and immediately
after the organisation, four others, by suspension of the rules, were
admitted to membership, making four counties represented in the
session for 1852 of the State Medical Society. Judging from the
record before us, at no time during the whole of the proceedings,
were more than twenty members or medical men present partici-
pating, encouraging each other, and exhibiting their desire to ad-
vance and be advanced, by giving tone to the morals of the pro-
fession, and adding importance and interest to its practical duties.
This is manifestly wrong, that of the hundreds who practice medi-
cine only fifteen or twenty can be found willing to combine for the
good of the cause. Are all the others so devoid of professional
pride that they are content to be esteemed by the particular few
who employ and pay for their services, and therefore do not care to
give their personal influence to the Society ? Or, if they possess
professional pride more than enough to sustain themselves, can it
be that they do not apprehend the advantages of union 1 The first
supposition is preposterously absurd, for very many practitioners
of medicine, In the state of Tennessee, feel as much concerned for
all that pertains to the profession, as the fifteen or twenty, who
have so nobly exhibited their determination and sentiments, in pre-
venting the session of the Society, for 1852, from being a perfect
failure. And to suppose a citzen living under our political institu-
tions, whatever may be his vocation, to be at all doubtful of the ad-
vantages of co-operation, of associated action, of union, is to suppose
him destitute of ordinary thinking capacity, is to give him a posi-
tion unworthy of respect — a condition and position which no one
with the responsibilities of a medical practitioner should have at-
tached to him.

Notices, 189

Some other reason must be found for this seeming apathy on the
part of deserving practitioners. And is it not true, that the al-
most positive want of attention to the morals of the profession ex-
hibited by Medical Societies, constitutes the sole and only cause of
their want of fullness of members, and largeness of influence, of
their ordinarily languishing condition, requiring the almost con-
stant labor of two or three individvals to keep the organisation from
annihilation. In our humble opinion this is the source from which
springs that want of combination on the the part of the whole pro-
fession of the state, which we see exhibited by the last session of
the Medical Society of Tennessee ; and we doubt not that similar
bodies, of other states, may look to the same source, for their ab-
sence of the vitality of maturity. The address of the President,
and the papers presented by the members are all productions of in-
terest and well adapted to advance one, but by no means the prin-
cipal object of the organisation, that of individual improvement by
comparison of observations and reflections on them, in practice ;— -
yet the records do not show us that any thing else was done, ex-
cept reading and discussing these papers.

The great Medical Congress has adopted a code of ethics; but
of what effect is that code, if the more circumscribed Associations
do not take measures to make it effective within the precincts of
their operations 1 And how are these measures to be taken unless
attention be called to the existing necessity, by propositions and
discussions ? But no mention, whatever, was made, as shown by
the record, to ethics, to morals, to the best mode of giving practical
importance to the well digested code, which has been printed, and
so generally, indeed, universally approved. We do not know, but
did not the application for dissolution of connection with the Soci-
ety, furnish happy opportunity for something to be said on this sub-
ject ? But we are saying much more than we designed, and yet
we dislike to stop. So well satisfied are we, that the code of eth-
ics is the only means by which the profession of medicine is to be
materially advanced, and that the code to be made efficient must be

presented and enforced on public attention, that we are anxious for
others to adopt our views, and therefore take as many opportuni-
ties as are offered, to attract the attention of those who nobly sustain
the organisation of Medical Societies, for to these Associations
alone do we look for the ultimate attainment of those objects which
the present condition of the profession demand.

190 Notices.

That our judgment in this particular is correct, is evidenced
by the advice given to a correspondent by the editor of a northern
weekly medical print. His correspondent desired to know what
to do when a competing practitioner violated the ethics; and his ad-
vise was, violate the code yourself — lex talionis being the only re-
course he could recommend to his enquiring reader. Can any
good to the profession or any personal comfort to its individual
members result from such a practice ? Besides, should a practitioner
decide his competitor for confidence to be culpable ? We say not.
He should be arraigned and tried by his compeers, and if found guil-
ty punished in proportion to the nature of the offence. But of what
effect is punishment now, even though it be expulsion from the
privilege of Society association, or of professional consultation ?
The culprit will laugh openly at such an action, and successfully
appeal to the public to be sustained. And we can not blame the
public, for we have failed to give it criterions on which it can rely,
to clearly distinguish the tvorthy and the unworthy practitioner of
medicine. We appeal then to the State Medical Society, and ask
a profound consideration of the duty which devolves upon it from
its name, and from its charter. Let it not say, the door is open to
those who desire if found worthy of, membership. But rather let
it awake from its ease, and strenuously endeavor to make itself, in
deed and in truth, all that its name imports, "The Medical Society
of Tennessee." And we would further suggest that, when, under
present circumstances, its members read the compliment paid by
Dr. Grimes, before the Indiana Medical Convention, the reference
of commendation be for the time forgotten, and the sentiments and
mode of attainment, be alone considered. — "In order to give effect
to our wishes and intentions on all that relates to the improvement
and elevation of our profession, we must act through our state or-
ganisation. For this purpose it is all important that the county
Societies should be well organised— as on their efficiency will de-
pend the weight and character of the State Society." The State
Society is organised — let it then adopt such measures as will co-
erce the profession to the formation of county Societies, and must
operate through the public.

The President's address sets forth a very important practical
truth, which, in our humble judgment, can not be too frequently,
or in too many different kinds of phraseology, presented to the

Notices. 191

medical profession. During our attendance on lectures, a certain
professor, as often probably as once a week, would introduce at
some point of a lecture, language like this, — "Gentlemen, never
visit a patient with your mind made up as to his condition, or deter-
mined as to the particular remedy which should be employed ; wait
until you see and fully examine your patient, and then do not find
a name for his disease, but a remedy suited to his essential condi-
tion." There are many practitioners who follow nosological dis-
tinctions, and attempt to conform in practice to the prescribed for-
mulae of books ; but we are inclined to the opinion, that ultimately
men will think for themselves, and exercise their own judgments,
corrected and perfected indeed, by an extensive acquaintance with
the opinions and observations of others. And this desirable object
is to be brought about, by the enunciation from prominent men,
like the President of the Medical Society, of such precepts as
strike directly at the root of the Upas, which destroys self-reliance,
by preventing close observation and laborious research — manuals,
hand-books, vade-mecums, and systematised works of "practice
made easy," of every kind and description.

Two of the papers in this number of the Record incidently set
forth the same great truth, which is so elaborately contended for by
the learned officer of the Society. The author of one of these has
just received his degree from an institution, of the faculty of
which the President is a worthy member ; and he receives no
small compliment in the fact that his pupil, in the construction of
his thesis, has aptly appropriated and applied the doctrine of in-
dividual peculiarity.

The address will bear reperusal, even in these days of multi-
plicity of thought and exuberance of language, and we are pleased
to see that it has been extensively distributed in pamphlet form,
distinct from the proceedings of the Society.

The President's paper seems to have given occasion to the mem*
bers to express themselves after the example set them, by the gen-
tleman, whose address we are discussing — "free from all restraints
and moving in all directions, and through all kinds of by paths."
One of them, whose energy and ability as exhibited in these trans-
actions, much incline us to regard him with great respect, used lan-
guage conveying an idea, that we are almost sure he did not intend.
What imports it "if an opinion does prevail in the west, that western

192 Notices.

physicians can only report cases ?" Are we therefore to leave the
field of observation and launch fearlessly upon the billows of hy-
pothesis and free discussion ? Shall we like Brown, Broussais,
and others seize hold of some great fact, or leading observation*
and indulge in specious argumentation, giving full play to the im-
agination, fill pages or volumes with language poetically beautiful,
give nothing a local habitation and a name, and call it essaying,
elaborating a system ? Would not this be indeed, sailors at sea
without compass or rudder ? Essays are valuable when they em-
brace all the observations which are necessary to a full, comprehen-
sive consideration of the subject on which they treat? But when
abstruse, or abstracted they have something of the same influence
on the mind that novels and light poetry exert — unfitting it, if ex-
tensively indulged, to calmly, slowly, perseveringly and surely in-
vestigate the sober realities of every day life, which is the busi-
ness of the physician. Though observations have been recorded
for many hundred years, very few, if any general principles have
been established in medicine, and until this can be done any at-
tempt at essaying them, will be illegitimate, however, much of a
genius the effort may prove the essayist to b?. We do not wish
to be understood as objecting to treatises on observations, suggest-
ing their probable bearing, and honestly testing their value, and
rationally comparing and contrasting them, and deducing the con-
clusions which such study will inevitably bring forward. But we
do most earnestly enter a caveat, against abstruse metaphysical,
hypothetical and gratuitous disquisitions on all subjects, but more
especially when they employ, as fixed and certain principles, sim-
ple observations, which are far from being universally applicable,
being liable to many exceptions. And we would further defend
the intellectual vigor of those who correctly record cases — whose
apt mind, ever vigilant, closely observes and accurately records
every, even the minutest, circumstance — for as straws shew which
way the wind blows, so nothing in nature, disturbed or undisturb-
ed, is too small to be neglected by the philosopher or the physi-
cian. Why is Sydenham, or behind him Hippocrates, reverenced
even now? Do their suppositions have any effect, in arousing
within us any of those feelngs which we all profess to have ? Or
rather is it not that we are forced to appreciate the accurateness,
with which they observed, and admire the care with which they

Notices. 193

recorded their observations. It is then, in our opinion, unfortu-
nate that any remark should have been made, and especially by
one, who must exert an extensive influence, which in any degree
depreciated the value of observing, and the importance of record-
ing observations. These only can be appealed toby the practi-
tioner, in times of trial, when he is anxiously tossed, desiring a
beacon light to enable him to avoid Scylla and Charybdis,which no
essay, no free discussion of general principles will furnish; — while
"we are enabled to discover, even in the commonest observations,
or such as are full of errors, peculiarities which may afford us light
in discovering or clearing up truths important in theory or prac-
tice." Q,uesnay tells us, after narrating several observations —
some illustrating and some disproving, certain points of treatment,
—"We can scarcely multiply them too much, since we must often
look through a great number of cases to find particular facts, which
may serve to establish or illustrate a truth, or simply to define its
limit in one direction, and in these researches we almost always
find that our present stock of observations is not nearly sufficient
to afford us the knowledge that might be drawn from them. Great
researches are therefore necessary, many facts must be collected
and exhibited in their bearings on the subject we are examining, in
order to elicit from them some rays of light, or to decide, not on an
entire mode of treatment, but on a single point of practice. * *

* * * * It is those only, who have acquired the knowledge to
be procured from several sources, who can separate the reality from
the semblance in such observations, who can detect the faults of
proceedings, which an equivocal and temporary success would
seem to authorise, and who can recognise good practice, even in
those cases in which the event has proved unfavorable." * * *

* * * It is only "the great masters who can properly employ
the narratives, of cases in reforming precepts which are erroneous;
in verifying those which are uncertain ; in tracing the limits of
those which are vague and indeterminate; in comparing the de-
tails of particular cases, which can not be brought within the or-
dinary rules, and of which the event is not sufficiently well
known to be allowed of their being fixed and reduced under pre.
cepts * * * * endeavoring, through the assistance of these
facts, and of those to be found in ancient and modern observations,
to settle doubtful or undecided points of practice, to detect faulty

194 Notices.

methods, introduced through prejudice and favored by false ap-
pearances; and, on the other hand, to discover and settle the true
indications to be followed in doubtful cases."

CIRCULAR.

To the Medical Profession in Tennessee and Kentucky :

It is known to you that the American Medical Associa-
tion is anxious to be furnished with correct and reliable
histories of epidemics prevailing in different portions of the
union. For this purpose they have divided the whole coun-
try into districts, and have appointed a committee to inves-
tigate and report upon the epidemics of each. To enable
those committees to discharge their duties to the best advan-
tage, they are to continue for five years.

It will be seen at once, that if the physicians of the Uni-
ted States will go to work, record their experience faith-
fully, and at the end of each year, transmit the result of
their observations to the proper committees, we shall soon
have a history of epidemics, greatly more valuable and re-
liable, and embracing a country vastly more extensive
than the profession has ever yet seen.

Is it necessary to argue this point? Is it needful to say
that this great object can be accomplished only by the con-
tributions of individuals ? Is it requisite that we say to
each individual physician, that he is personally called on
to furnish any facts within his knowledge in aid of this
great work ? It is hoped not.

The committee appointed for the states of Tennessee and
Kentucky desire carefully observed facts upon any point
connected with epidemics, but would suggest particular at-
tention to the following heads.

Causes supposed to give rise to the epidemic.

Causes which favored its spread.

Causes which retarded its progress.

Prophylactics.

Age, sex, color, employment, diet, and habits of exposure,
and temperance of those most liable.

Time and extent of its prevalence.

Prominent symptoms during its different stages.

Proportional mortality — post mortem appearances.

Treatment.

Medical topography — including the nature of the soil,

Notices.

195

its geological character — character and average tempera-
ture of the springs and wells.

Meteorological observations — mean monthly and annual
temperature, weight and moisture of the atmosphere, &c.
It is considered important that all cases treated should
be reduced to tables, (a copy of which is annexed,) and re-
turned with the reports.

As the members of the committee are widely separated,
it is very important that all reports should be made by the
1st January each year, to some one of them.

W. L. Sutton, M. D., Georgetown, Ky.

Asbury Evans, M. D., Covington, Ky.

Frank A. Ramsey, M. D., Knoxville, Tenn.

Thomas Lipscomb, M. D., Shelbyville. "

E. B. Haskins, M. D., Clarhsville. "

Georgetown, Ky., July 23, 1852.

NO. ATTENDED.

Diseases.

Cholera,

Cholera Infantum,

Diarrhoea,

Dysentery,

Erysipelas,

Fever, Bilious,

Typhoid,
Scarlet,

Hooping cough,

Infl. uenza,

Measles,

Small-Pox,

under 15

15 to 40

over40
M~~F

NO. DIED.

15to40

MIF

ov.40

Av'r.
time
of at-
ten.

[£r" State how many of the above cases were seen secondarily,— in consul-
tation or otherwise.

196 Notices.

"A History of the Art of Midwifery" by Augustus K.

Gardner, M. D.

This is a lecture delivered at the College of Physicians
and Surgeons, New York, introductory to a course of pri-
vate instruction. Dr. G. shews up, most perfectly, the worse
than foolish attempt, which has been made to introduce
women into the hard and laborious occupation of practition-
ers of medicine, in any of its branches. The lecture would
do as a tract for popular vending, if the profession had any
medium, by which it could be given to the public. If we
ever visit Ne w York city again we intend to hear Dr. G.
lecture.

Quarterly Summary of the Transactions of the College of
Physicians of Philadelphia, May to July inclusive, 1852.
From a desire to give to the Summary of the Transactions
a more extended circulation than has heretofore been the
case, the College of Physicians have been induced to enter
into arrangements with Messrs. Lippincott, Grambo &JCo»,
to assume the publication of the work. Under this arrange-
ment, a new series of the Summary is commenced, and from
the increased facilities now afforded for its extensive distri-
bution, the work may be readily obtained by ^uch members
of the profession throughout the country as may desire to
possess it. All such will please address the publishers, by
whom, in future, all the business transactions connected
with the issuing of the work will be conducted.

Publication Committee of College of Physicians.
Philadelphia, April, 1851.

The Quarterly Summary will be issued in January, April,
July, and October of each year. It may be obtained from
Booksellers and Periodical Agents, or from the Publishers,
at One Dollar a year, or Twenty-five Cents a number.

Any person remitting one dollar by mail can have the
numbers sent as soon as published.

Notices. 197

Elements of Chemistry, by Thos. Graham, F. R. R., etc., ed-
ited by Robt. Bridges, M. D., etc. Part 1. Philadelphia :
Blanchard fy Lea, Publishers.
We thank the publishers for a copy of this work with

the above title. It has been received too late for notice in

this number ; but in our next, Prof. Mitchell's opinion of the

work will be given.

The second annual announcement of the Medical Depart-
ment of Nashville University has been received, and reads
like similar announcements. The class, last (first) session,
was largely over one hundred, and we have conversed with
an intelligent physician, of a neighboring county, who re-
ceived his degree from the Nashville school, and who
speaks in terms of commendation of the entire faculty. We
wish this school as much success as it may intrinsically de-'
serve.

EDITOKIAL,

In an article under the head of Relations of the American Med-
ical Association to the General Public, occurring as an editorial in
the first number of the Record, we urged the necessity of the
adoption of such measures, by the Medical Congress, as would af-
fect the body of the people. The Association has met, and from
the proceedings as published we can not see that any thing effec-
tive has been done towards attaining the great end or object of its
formation. The ordinary routine of business was transacted, re-
ports sent up and referred, committees continued and appointed,
changes of the constitution suggested and discussed and socialities
enjoyed. But what good will all this do towards pruning the pro-
fession of unworthy offshoots, offensive members and rotten selfish,
ness? What wots it if a thousand doctors meet, and recommend
ten thousand others to prosecute diligently the studies pertaining
to their vocation, if the millions, who sustain them, are not furnish-
ed with a tangible assurance that the thousand themselves are more
devoted to the profession, for itself, than the ten thousand intended
to be affected by the recommendation ? We feel that nothing, ab-
solutely nothing, is to be attained by the Association unless it di-
rects its energies so as to affect medical men, through the public,
by which they are sustained. We are sorry that there are not
more journals attempting to press this view on the Association,
through which so much good may be produced. We profoundly
appreciate the fact that the public is lethargic, even to indisposition,
in the consideration of a subject so momentous as the relations sus-
tained by the profession and practitioners of medicine. And we
think the press should speak positively, so as to influence the As-
sociation to adopt such a policy as will induce the public to lay off
its lethargy, and zealously, though calmly investigate these rela-
tions. Until this investigation is made by the public, the Associ-
ation may reiterate the declaration that, the standard of medical
education is too low in these states, may again recommend college
faculties to extend their lecture terms, and disapprobate the college
policy, of receiving a stated length of time professedly employed

Editorial. 199

in practice, as equivalent to attendance on instruction — it will all
avail nothing.

It is the public, to which the worthy of the profession, in com-
mon with the empiric, must look for encouragement, if not for sup-
port. And what is the condition of the public, as regards medi-
cine and practitioners. Many people, probably, otherwise, well
informed, know but little of the extent of the vast field embraced in
the cycle of the sciences which, collectively, constitute the science
of medicine, and regard it as simply a conjectural art, and con-
temptuously consider its followers as living upon the misfortunes
of their fellow men. Some have an opinion that the sum total of a
physician's acquirements, consists in his possessing an agent or
compounds of agents, with which to subdue particular symptoms
or evidences of disease; and others, that the physician's office is,
to puke, purge, and bleed, and with the ability to exercise these
functions, his mission is completed, his duty is discharged, and he
may engage in whatever frivolity, or other business his inclination
may prompt. While another class have a vague idea that the
practitioner of medicine should be endowed with a power of in-
sight — a vision intuitively penetrating — beyond others, and in their
search lor the realization of their idea are carried away by every
wind of doctrine, and are led captive by every successively propos-
ed nostrum, or system of dishonest empiricism.

Sadly, indeed, sadly have the times and manners changed in
this respect, since the age of Chiron of Greece, who is fabled as
possesing all the fleetness, strength and beauty of the noble horse,
in connection with the highest of man's mental capacity — and
who was resorted to, for the instruction of princes and heroes. Or
since iEsculapius, who first prosecuted medicine as a science, but,
whose name, in this degenerate age, is so frequently profaned. Or
since Hippocrates, whose close observation, judicious reasoning,
and wise conclusions, commanded homage from his cotempora-
ries, and universal^reverenee ; and w T ho is to this day, in all lan-
guages, designated as the Father of Medicine.

Sadly, indeed, has been the change in the mind? of men, since
the golden period of Greek and Roman-literature, when medicine,
from the nobleness of its objects, rather than from any superstitious
regard for its practitioners, was called and esteemed as the Di-
vine Art. Aye — and sadly has been this change since the phi-

200 Editorial.

losopher, of Britain said, that of all men, he had found physicians
to be the most liberal as well as the most learned.

But why this change? The answer is ready. The public is
ignorant, wilfully and deplorably ignorant, of the noble objects at-
tempted to be attained by those who correctly appreciate medicine
as a science or an art, and hence follows, the inevitable conse-
quence, the absence of demand for perseveringly and zealously
laborious physicians. True, every individual estimates his own
medical adviser as the best — as of all others most worthy of confi-
dence. But by what criterion does he form his judgment ? Does
he regard medicine as a conjectural art, or a mere system of guess-
ing? If so, he doubtless reposes his confidence upon the broad
principle that practice makes perfect, and that the oldest is the best

guesser.

Does he regard medicine as a system of fixed facts, like the mul-
tiplication table, a series of symptoms and their remedies to be
memorized ? If so, he is reposing his confidence from other con-
siderations than those which are professional — it may be from per-
sonal, political, or religious association, or family relationship.
Or, does he have an idea of some grand catholicon, some universal
specific, which has been discovered and is no generally known, or
which is yet to be discovered ? The confidence of such a one is
reposed but to be withdrawn. He has one practitioner to-day, and
another to morrow; now has full faith in the uniform healing pow-
ers of cold water, and, anon, his whole dependence is placed on
Graflenburg Preparations, Jayne's Pills, Goeliek's Matchless San-
ative, Townsend's Sarsaparilla. And what mind, worthy of the
vocation, is so destitute of sensitiveness, as to be willing to be em-
ployed for the advantage of one whose confidence has so slim a
foundation, so weak a source ?

Indeed, the public has no means, which, it has used, by which
to judge of medicine and medical men. Hence, Dr. Johnson, in
his life of Akenside, observes: — "A physician, in a great city,
seems to be the mere plaything of fortune ; his degree of reputa-
tion is, for the most part, totally casual; they that employ him,
know not his excellence ; they who reject him know not his defi-
ciency. By an acute observer, who had looked on the transactions
of the world, for half a century, a very curious book might be writ-
ten on the Fortunes of Physicians. "

Editorial. 201

This lethargy on the part of the general public to erect a stan-
dard, by which to decide the relative merit of every one who pro-
poses to assume the heavy responsibilities of the practitioner of
medicine is the fountain head of all those myriad rivulets of impo*
sition, which have run forth, and are now disseminated throughout
the world, — forming pools, puddles, streams, and seas of quackery,
until now, as the waters constitute three-fourths of our physical
globe, so the waves of empiricism in medicine, wholly surround
the solid ground of true science — it being but occasionally encoun-
tered, in smaller or larger masses, as islands or continents, accord-
ing to the amount of general intelligence, congregated at particular
points. See the number of disqualified practitioners, who assume
familiarity with the writings and opinions of the worthies of the
medical profession, and who freely pass opinions on the nature of
disease, and without a blush prescribe the most deadly drugs, with-
out a knowledge of the nature of the agents employed. Bear with
a reference, by way of explanation, to a case which fell under my
own observation. Every body knows that the ordinary impression
of Tart. Emetic, whether in powder, solution, or in the form of
Antimonial wine, is to produce vomiting. There are many practi-
tioners of medicine, who are unaware of any other impres-
sion — ascribing the prostration, which ordinarily ensues, to the
nausea of the stomach, and the effort of the vomiting. It is, how-
ever, a fact that the agent exerts a direct effect upon the tissue of
the heart, depressing its action and its power, and if the adminis-
tration of the agent be continued beyond a due amount, or for too
great a length of time, it will so impress this central organ as to
wholly prevent it from acting. Of course so soon as the pulsations
of the heart cease, all the manifestations of life disappear. And
this effect is not secondary — for another fact prevails, that after a
time, sooner or later, and the larger the doses of the agent, the
sooner is the state observed, the stomach will tolerate the antimony
— no nausea will be occasioned, no vomiting will be produced, and
the only evidence of the agent impressing the system is to be ob-
served in the more or less rapid reduction of the force and frequen-
cy of the pulse, the fullness of the surface, and the declension of
strength — all owing to a want of a due supply of blood. In my
travels, I have met with a practitioner of medicine in the enjoy-
ment of the confidence of a respectable portion of a large and rather

202 Editorial.

intelligent community, to whom all these facts were unknown.
And to this practitioner was entrusted a case of disease, ordinarily
called croup, in a child. He administered large and repeated do-
ses of Tart. Emetic. The first dose occasioned an effort to vomit,
after which, to use his own language — "notwithstanding the fre-
quent repetition of large doses of Hive Syrup, I could not produce
vomiting, and the child died in less than five hours." To the mind
of any practitioner, as familiar with the impression of medicinal
reagents as he ought to be — the cause of death, in this case, was the
frequent and large doses of Hive Syrup. But this practitioner is
not alone. He has his cotenants, and the public support them all.
But see again, — the mesmerist, who makes his passes, — and
disease flies before the necromancy, like mist before the morning
sun. And yet again — that huge delusion, Hydropathy, and the
more nonsensical and puerile system of Homcepathy. These do
not prevail extensively, throughout the inland states — but nearer the
seacoast of our own, and throughout the whole of foreign countries,
they exert all the influence of the latest novelty — the most recent
innovation ; and is it not proper to inform the public that these are
delusions, and to give them evidence, by which the information
will be established ? Is it not meet for us to prove that as regards
Hydropathy, or the use of water as a remedial agent, it is as well
understood by the educated physician, as that of any other agent,
which he employs, and the error, if error it is, — for I am persuad-
ed it is dishonesty — in the practitioners of Hydropathy, is the uni-
versal and unconditional application, internally and externally, in
accordance with certain fixed rules, or a precise routine, of cold wa-
ter? And should we not show that of Homcepathy, even thus
much can not be said? that Hanneman, its founder, in propound-
ing hie system, followed the example, which has been practiced by
all imposters in medicine, since the days of the empiric of Nero's
reign? He declared, — "I have founded a new sect, which is the
only true one. I have been forced to this, because, none of the phy-
sicians, who have preceeded me, have discovered any thing useful,
either for the preservation of health, or for the cure of disease, and
because Hippocrates himself, has put forward many dangerous max-
ims." With alike impudent boldness, growing out of a knowledge
of the fact, that men are more prone to indulge ease, than to labori-
ous investigation, and are therefore apt to repose confidence in those

Editorial 203

who assume with most arrogance, Hanneman says of medicine: —
"Since this art only consists in a gross imitation of a dangerous and
insufficient process, it must be admitted by all, that the true medi-
cine was not discovered until by me. It is the infallible oracle of
the art of curing — it is the sole mode of really curing disease."
Should not the fallacyof these teachings be exposed, which derives
all diseases from a scource which can but bring the blush of shame
to every fair maiden who is forced to acknowledged herself sick ;
whose pain or ache, whose cold or fever, the wisdom of a Homce-
pathic doctor, will pronounce to be evidences of her system's puri-
ty being destroyed, by a taint of the dirty itch, or the loathsome
pox ? Or should we remain silent, astounded by the profound in-
vestigations, which led to the discovery of the universal prevalence
of the itch and pox, which, however, must sink into insignificance,
when brought in comparison with those which resulted in another
Hannemanic discovery — the existence of property without mattery
the development of his plan of curing disease — and, notwithstand-
ing, the great plenty of the fluid which has been benificiently fur-
nished, for the use of all creatures, there is yet, not enough to de-
velop the full potency of any single medical substance. Take a
single grain of any agent, dissolve it in a given quantity of water,
take one drop of this solution, and add to it one thousand grains,
by weight, of water, give the vial one, two, or three shakes down-
wards, and one, two, or three shakes upwards — each shake devel-
oping a particular amount of potency — take one drop of this solu-
tion, and add to one thousand grains of water, and so on to infinity
i— not omitting the upward and downward shakes, and of course,
long before the ultimate dilution has been attained, the original
grain of medicine has so far disappeared, that the most delicate
and skillfully applied chemical tests will fail to detect it, and yet
its power remains. Nay — it is but just being developed — for a
single drop constitutes a dose, and must not be repeated oftener
than once week. *

But of this small thing we will say no more. It is a toy for the
amusement of grown up children, who have been spoiled in the rear-
ing, and whose minds, like a hysterical system, are so very im-
pressible, as to be much more easily convulsed by the light kiss of
an evening zephyr, than by the terihc howling of the overpow-
ering hurricane.

2€4 Editorial.

Cupidity, in operating upon the credulity of mankind, presents
yet another feature, which merits contempt. We are living at a
period in the drama of life, when the scenes present the most hor-
rid feature ot man's character — avarice in the mantle of beneficince.
Scan the columns, issued weekly from the press, which should
bear intelligence, improving to the head and to the heart, of the
indweilers of the cot and of the mansion, proclaiming the assumed
virtues of some inert, or$ peradventure, noxious compound; — on
the side-walks of the streets of the cities and villages, and even on
the cabin doors along the road-side, as we journey through the
country — enblazoned in bold-faced type, adorned with the beauty
of a steel engraving, and sustained by the certificate of some astute
justice of the peace, or more erudite expounder, or executive of
the law, some minister of religion — and perhaps "Doctor" — we are
met by a patented nostrum, whose power to overcome diease, in
any form has been proven by a long experience of a series of years,
and with such satisfaction that those who have, "by the advice of
some kind friend and the blessing of God," once used it, would not
be without a box or a bottle of it for a great consideration.

The proprietors of these nostrums are aware that arrogant as-
sumption has much more effect, than a process of true reasoning,
and hence, the only difference between their advertisements, is in
the greater positiveness, with which one than another, asserts his
claims to the position occupied by the great benefactors of man —
for each has discovered remedies, or invoked compounds before
which disease will disappear, like the blight of winter's chill be-
fore the genial warmth of summer's sun. By way of illustration,
hear Dr. Sherrman : "Worms kill thousands, — children in par-
ticular, adults in general, — many are doctored for months, for some
other imaginary disease, when one box of Sherrman's Worm Loz-
enge would effect a cure. And then, my Camphorated Lozenges
■ — they act like a charm upon the agitated and shattered nerves, as
Sherrman's Poor Man's Plaster does upon Rheumatism, Lumbago,
pain or weakness in the side, back, breast, or any part of the body."

The title of these nostrums can not be given ; their name is Le-
gion, and they exert a pernicious influence on the moral as well as
physical constitution, in many instances presenting ideas clothed
in language, well suited to cause the cheek to tinge, and arouse
feelings of virtuous indignation, if they do not give rise to emotions

Editorial. 205

more venal and vicious. But the evil does not stop here. These
advertisements are the source, from which the great body of the
people obtain their ideas of the laws of life, of the nature of disease,
and the art of applying remedies. And often is it the unpleasant
lot of the physician, to sit and listen to a long disquisition on the
influence of the blood, the stoppage of the insensible perspiration,
or something else, — instead of having, as he should, a frank, free
and full statement of symptoms, from those who ask for opinions,
or desire an effort of his skill. Nor is the end yet. Some
practitioners — of whom there are far too many, whose only emula-
tion is the confidence of the people for pecuniary ends, without a
regard for the dignity or responsibility of the profession — find it
much easier to fall in with the current, than to correct the error,
seemingly acquiesce in these general ideas of the health, disease
and treatment, and finally from sheer neglect to keep themselves
informed, really believe the very positions which had first excited
their laughing propensities. And as similarity of thought — par-
ticularly with republican people — constitutes a criterion of sound
judgment, the practitioner's qualifications are never doubted, and
he attains the character forsooth, of respectability, — a point of re-
flex influence for erroneous opinions, giving them all the weight of
principles, or trueisms. For the general public to be so gullable as
to contribute to the sustenance of the huge monster, Patented
Physic, which, indeed, preys upon the body politic, physicians can
now only mourn. But when men professing to be members of the
medical profession lend their aid, it is an announcement made by
themselves, of their own dishonesty or ignorance — either horn be-
ing sufficient to render them unworthy of the position of medical
advisors. In 1825, Dr. Smith, of Boston, hit off the evils of Pat-
ented Physic, and his language may be, not inappropriately, in-
tioducednow. "Patent trusses, patent teeth instruments, patent
lancets, and patent pills, are in our opinion all of a piece ; and
when medical men countenance, and even patronize such useless
efforts of human ingenuity, they encourage artizans, who might be
better employed to labor entirely in vain ! Whatis there in this
country that does not go by patent? We were lately acquainted
with a gentleman, who wore a patent hat; bought patent boots, with
patent cork soles ; and daily besmeared his toes with Conway's
patent Corn-plaster ; not satisfied with this, he crawled into a pa-

206 Editorial

tent doe-skin shirt ; kept up his clothes with patent suspenders ;
and kept his chapped hands warm with patent spring-back gloves;
and, finally, falling sick with a fever, took forty dollars worth of
patent physic from a patent doctor, and after languishing awhile
on one of Jenk's patent elevating bed-steads, he died, as all other
patent things generally do prematurely ; was placed in a patent
cedar-wood coffin ; borne on a patent spring-hearse, to a patent air-
tight tomb, where he now lies, a striking emblem of the numerous
inventions, which claim the protection of our American patent
laws."

Let these errors of the public, in relation to medicine, be fre-
quently presented, with the hope of exciting the public to reflect ;
confident in the expectation, that such reflection will lead to co-op-
eration with the wisdom of the profession in the efforts now ma-
king to guard the public against disqualification, deceptive systems,
and the base decoys of thieving patentees. The support of these
errrors has its root in the fertile ground of ignorance, for few, how-
ever learned, except those who have made medicine a study, ap-
preciate its objects and capacities.

The subjects, investigated by the politician, the lawyer, theolo-
gian and merchant, are so intimately related, that even an approach
to perfection in either vocation, inevitably leads to a knowledge of
the objects and capacities of the others, and imparts an ability to
apprehend, in some degree, the attainments and qualifications of
those who fill the several positions. And while the studies of the
physician, comprehensively considered, force him to respect other
vocations, and, in some measure, to estimate, correctly, the attain-
ments of those, who follow such vocations ; yet these studies,
which are essentially his, do not, necessarially, demand investiga-
tion, from the members of general society. Among the voca-
tions of men, its own peculiar branches stand like a parenthesis in
composition, — those who would understand it must read all that
goes before and follows after — though the^rest may be fully com-
prehended, with but a passing glance at the parenthesis.

To the politician, the history of the rise, progress and downfall
of nations, may be as familiar as house-hold words ; and the con-
stitution of states, and the influence of circumstances on govern-
ments be profoundly appreciated, involving as it does an exten-
sive acquaintance with law, commerce and the influence of

Editorial. 207

church association, and religious sects. But in attaining this
knowledge he has but little occasion to know any thing of the or*
igin, growth and decay of his own system, — of the multifarious in-
fluences which affect it.

By the lawyer, the principles of his profession may have been
mastered, ramifying as they do into the remotest nook of human
investigation, and an ability commanding respect if not veneration,
have been acquired to wield his knowledge in the promotion of
virtue and defeat of vice , in the protection of innocence and the pun-
ishment of guilt. But in attaining this mastery, he has had but
little time to acquaint himself with the laws of life, or of human or-
ganisation, bearing as they do, on some of the most important ques-
tions upon which he is called to exert his powers, — and, which he
perceives are in their relations sufficiently extensive to demand in-
defatigable labor for many years.

By the preacher, the abstrusities of theology, may have been
wholly removed by research and 'study, — and the beauty and ne-
cessity of the sublime teaching of the Bible be so keenly felt as to
make him effective, both in precept and practice, in inducing men
to attempt a life void of offence, and an exercise of a faith which
will remove mountains. To enable him faithfully to depict vice,
and vividly to draw the contrast with virtue, to give strength to his
efforts, and durability to effects, he has found it necessary to read
history, look into law, and investigate the influencs of wealth,
competence,'and poverty. Yet to a physician, — who knows that
a proper acquaintance with the reciprocal influence of mind and
body, would greatly contribute to the attainment of the preacher's
object, — it seems strange, that generally theologians have but a
vague idea of the nature of the union of spirit and matter.

To the physician, who regards the duties which his position
imposes, and does not esteem them as discharged by ordering the
administration of a drug for a consideration, the philosophy of med-
icine embraces, to an extent, the whole cycle of studies, which de-
mand the closest investigation from the learned, in every profes-
sion, and, therefore, he can not be justly esteemed as a member of
the profession who does not acquaint himself in some degree with
the objects and capacities of other professions and other callings.

To the physician, the air, water and earth, and their productions,
the mysterious operations of the human organisation, and the hu-

208 Editorial.

man mind, and all things and circumstances which may possibly, or do
positively exert an influence upon them, must be subjects of inves-
tigation and reflection if he desires to "feel conscious that he treads
upon a firm ground, and possesses not the ostentatious, but the ab-
solute knowledge which is necessary for the treatment of disease."
It is in deed and in truth a "profession which demands the entire
man — a thorough self-dedication to the object contemplated."
"The objects of the medical profession are to cure the disease that
has been produced, and to prevent the diseases whose latent caus-
es are ready for development. In accomplishing these objects the
profession, no doubt, commit errors, for it is fallible — and overlooks
truth, for it is human." But this fact constitutes no reason why
the public should waver in theirsupport of legitimate medicine and
of those who devote their whole time in attempting to forward its
legitimate interests. It is no reason why the general public should
say, this man will answer our purpose, and sustain from extrane-
ous influences, those whose knowledge is limited to the symptom
and its presumed remedy, or leave the safe ground of true science
and throw their confidence upon the dangerous fallacies of hypo-
thetical assumptions, and the bombastic operatives of secret com.
pounds.

It has been said that the public hasno means by which to judge of
medical men and medical matters. As regards the former, Rhazes,
an Arabian physician of the ninth century, who flourished in the
great city of Bagdad has left the following advice.

"Ascertain with care the antecedents of the individual, to whom
you propose to intrust that which is dearest to you, namely, your
health and life and the health and life of your wife and children.
If that individual waste his time in frivolous pursuits or in parties
of pleasure, or if he cultivates, too curiously, arts foreign to his pro-
fession, as music or poetry, or if.especially he be addicted to wine,
beware how you entrust to such hands s6 precious a deposite. He
only merits your confidence, who has applied himself, at an early
age, to the study of medicine, attended upon able masters, seen
many sick, and joins personal observation to a diligent perusal
of the best writers ; for it is important to witness everything or in-
vestigate every thing for yourself. The knowledge and experi-
ence of the single individual compared with the knowledge and
experience of all men, and of all ages, is like a small thread of wa-
ter by the side of a mighty river."

Editorial. 209

But this advice is rather too specific. Rather should the pub-
lic be taught to determine, in relation to medical men and medical
matters, in accordance with the philosophy of Heracletus and
Democritus, annonnced 400, B. C. The one taught, that "reason
by means of the senses is the judge of truth." The other that,
"there are two kinds of knowledge — one obscure, derivedfrom the
senses, another genuine, obtained by the exercise of thought upon
the nature of things." In short let the mind act, in relation to
medicine, as it does in relation to any other subject, which the ne-
cessities of mankind demand shall be investigated and sustained,
express opinions, and pnrsue a definite line of action only after rea-
soning upon carefully collected, or established data. Let them,
the great association, furnish these data, and place them before the
public, and in our humble judgment, the profession will soon be
quit of its ignoble attendants, and will stand forth in its own intrin-
sic beauty and glory, demanding and receiving respectful commen-
dation from all men.

Consultation.
We have mislaid the Journal which makes reference to
a resolution adopted by some society forbidding its mem-
bers to hold consultation with any practitioner who does
not implicitly respect the Ethics of the American Associa-
tion, which are approved as being applicable to medical
men. This is all very well, if the public in whose midst
that society operates has been correctly informed as to the
demands and their reasonableness, of the code of Ethics.
But what influence can such a resolution have if the peo-
ple extend support to the offending members ? If the peo-
ple have not been shown that any violation of that code
can not and will not be perpetrated, except by men unwor-
thy of confidence or support, either from professional or
moral disqualification, those against whom the weight of
the resolution will fall, will cry persecution, and arouse a
furor of sympathy in their favor that will inevitably force
them into professional acts and high social position. We
repeat that, in this degenerate age, when Franklin's maxims

H\0 Editorial.

of economy are far more important than his philosophical
precepts or his moral practice, the majority of men are to
be influenced alone by a line of policy which will materially
affect their monetary interest. And so far as medical prac-
titioners who are liable to fall under censure when tried by
the Ethics of the American Medical Association, are con-
cerned, the people to whom they look for succor and on
whom they rely for support must apply the rod which will
arouse them to an effort to become physicians, and to deport
themselves as gentlemen. This rod is nothing less than a
full and positive withdrawal of that countenance and confi-
dence which furnishes pecuniary return. We would like
to know of what avail such a resolution would have in a
community where the Ethics are not known, or if known>
are not appreciated ? In a community, for illustration, in
which the fact of a practitioner asking or permitting coun-
sel to be called, is regarded as an evidence of personal in-
competence, and which opinion is favored by some w r ho en-
joy a large measure of the confidence of that community,
how effective would such a resolution as the one referred
to at the commencement of this paper, prove ?

The code of Ethics of the Association should be printed
in a cheap form, and physicians should industriously circu-
late it amongst the people, and from time to time, different
sections of its several articles should be explained and
consulted on in conversations and publications, so that any
possibility of misunderstanding may be prevented.

•Thus, the 6th section of Article 1st of the Ethics reads:
"Consultations should be promoted in difficult or protracted
cases, as they give rise to confidence, energy, and more en-
larged views in practice." But this is an assertion, and
though evidently correct in the view of the enlightened
and conscientious practitioner of medicine, is by no means
so clear to the minds of the great mass of people. The
physician's footman who turned Doctor and obtained ninety-
* - nine patients to his master one, would denounce the truths
of the declaration of this section, and most efficiently dis-

Editorial 211

countenance consultations, by his direct appeals to the peo-
ple, who as yet have not been shown by the physicians how
to distinguish true attainments in medicine from the as-
sumption which is sustained by rampant boasting, or by
the more durable confidence gained by insinuating cunning.
Let the people know, that the most extensive and distin-
guished practitioners demand at times consultations with
their equals, and let some of the circumstances under which
such consultations are deemed to be essential, be published
and extensively familiarized to the public, and then the im-
mense advantages of consultations will be appreciated, and
those who practice medicine alone as a trade, will soon be
forced either out of the profession or to a different deport-
ment.

But we ean illustrate our position. Under present cir-
cumstances, with the opinions of the very best obstetri-
cians that all instrumental aid should be resorted to only
after consultations, and the edict which we have quoted, of
the Ethics, before them, how many practitioners, without a
moment's hesitation, and on their own individual responsi-
bility, apply the forceps, or perhaps more frequently, the
instruments which destroy the child? If the public is cor-
rectly informed, this habit will cease ; for so soon as a prac-
titioner announces this opinion, that his patient to be deliv-
ered of her child, requires instrumental aid, if he does not
suggest* the friends will demand that another obstetrician,
equally as responsible, be summoned. And what is neces-
sary to the correct information of the public on this point,
but simply putting the character and opinions of such men
as Lea, Collins, and others, in such a position as to be known
and read of all men.

Lea, one of the most extensive practitioners of Mid-
wifery in London, tells his pupils : "In all cases of protract-
ed and difficult labor in which you consider it requisite to
employ the forceps, or to perform the operation of craniot-
omy, or any other operation in Midwifery, you will pro-
mote your own peace of mind, and professional interests,

212 Editorial.

and the welfare of your patients, by previously consulting
another experienced practitioner, whenever it is practicable
so to do. When exhausted with fatigue and watching, we
are not in a condition to form a sound opinion respecting
the necessity for the interference of art, and it is agreeable
in all cases of difficulty and danger, to have the responsi-
bility divided by a consultation, and mistakes in practice
prevented by every means in our power."

And again, he enforces precept by practice, for he says,
"Of one hundred and twenty-seven cases of difficult labor,
in which it was necessary to deliver by opening the head, I
do not believe there is one in which the operation was re-
sorted to without a consultation, and the necessity and pro-
priety of the measure fully admitted."

Ramsbotham, a British obstetrician, whose elaborate
work on the Process of Parturition is frequently consulted
by those who are most extensively practiced in the art, in
treating of instrumental labor, says : "As soon as a neces-
sity for instrumental interference appears, two questions of
some importance will naturally offer themselves to our
mind ; the first, whether we shall call in the assistance of
another practitioner, to advise us by his counsel, to aid us
in the operation, and to divide with us the responsibility of
the case ? Narrow policy might perhaps whisper to us,
that we should not unnecessarily throw our characters into
the hands of a neighboring, probably a rival, and perhaps
not very friendly, practitioner. We may be led to argue,
that we are giving him an undue superiority, that he may
be tempted to take advantage of the confidence we repose
in him, to worm himself into the good graces of our pa-
tient ; that he may blazon it abroad he was consulted in a
case so difficult, that we were incompetent to its manage-
ment, and that to his judgement and dexterity, the safety of
the patient was to be attributed. A selfish and narrow-
minded feeling might prompt us to reason thus ; but I
should hope there are few men in the profession who would
be guilty of such a breach of professional etiquette — not to

Editorial. 213

say of honor — as is implied in this suspicion. But let us
even look at the darkest point of the picture, we will sup-
pose it probable that the person we consult may take ad-
vantage of our confidence, and endeavor to supplant us by
specious misrepresentation ; still I would recommend that
the same principle should be acted on ; and strong in our
own acquirements, in^he integrity of our intentions and the
propriety of our conduct, that we should disregard the* ill-
natured aspersions which envy or malice may circulate to
our discredit , for there is such a comfort in the division of
responsibility, such a consolation in knowing, if the case
turns out ill, that we have not acted entirely on our own
judgments, but that another party has sanctioned the means
employed, and that all has been done which foresight should
suggest : that we should be unnecessarily adding to the
anxiety we must undoubtedly feel, if we allow any petty
jealousy to prevent our availing ourselves of the opportu-
nity offered — provided, indeed, the loss of time which must
elapse in seeking assistance would not endanger the woman's
safety." ***** "Having, then, called in the ad-
vice and assistance of a medical friend, having concluded
with him that the patient's safety demands that instrument-
al delivery should be had recourse to, &c, &c."

Churchill, with whose work on Midwifery the profession
in America is familiar, hut whose character as an obstetri-
cian is vouched for by the positions given him by the coun-
sellors of the Sydenham Society, in selecting him to edit its
reprints of monographs on the diseases of women, says:
"It is, 1 believe, an axiom in which 1 fully concur, that no
operation should be attempted without a consultation, if it
be possible to obtain one."

And Collins, who was concerned as obstetrician in six-
teen thousand six hundred and fifty-four births, says : "A
prudent use of instruments in the practice of Midwifery, is
of great importance ; but the necessity of freeng our pa-
tient from impending danger, should alone induce us to re-
sort to them. In every instance, where practicable, previ-
o

214 Editorial.

ous to doing so, it is desirable a second physician should be
consulted, in order to satisfy both the friends of the patient
and ourselves, that we are doing what is essential for her
safety." He further tells us "the propriety of consultations,
previous to the use of instruments, I first heard strongly ar-
gued by Dr. Labutt, and few men have had more ample op-
portunities of acquiring experience."

Meigs, of our own country, says, of applying the forceps,
"If time permits, some professional friend should be invited
to witness and sanction the operation." And again, of the
destruction of the child, he says : "Yet, notwithstanding the
facility with which the operation of embryulcia may be
performed, it is one so unnatural, and so shocking to the
feelings of all concerned, that it ought not to be done with-
out very satisfactory reasons for it ; and in general not with-
out consultation and agreement with a medical brother. —
In those instances in which it becomes necessary during the
life of the child to resort to this mode of delivery, the most
formal consultation ought to be regarded as indispensable."

Acquaint the public with opinions, such emanating from
the very best men in the profession,and the frank, candid,gen-
tlemanly and conscientious physician will be so much favor-
ed that the resorts at present relied on by the ignorant, the
smatterer, and the practitioner of personal observation, will
avail nothing — they will be "as sounding brass and a tinkling
cymbal," and they who now successfully apply them, will
have to seek others, or hang their harp upon the willow. —
Acquaint the public with such opinions emanating from the
very best men in the profession, and consultations will be-
come dignified and as common as they are now rare, and
then, and not till then, will expurgating resolutions be ef-
fective.

Editorial. 215

We have received letters from Dr. W. Jones, of Nashville,
chairman of committee to report on Continued Fevers, and
from Dr. B. W. Avent, of Murfreesborough, chairman of
eommittee on Operative Surgery, appointed by the State
Medical Society, to collect such information as the physi-
cians of Tennessee may impart, for the purpose of preserv-
ing the history of Continued Fevers, and of Operative Sur-
gery in Tennessee. The desire of these gentlemen is to
have a correspondent in the person of every practitioner in
the state, and under the present condition of the profession
we can not see any other mode by which their ultimate ob-
ject can be attained. If there was a Society in every coun-
ty, their labors would be exceedingly easy, and rather
pleasant than otherwise. We hope, however, that practi-
tioners will regard the appeal, and facilitate the committee-
men, by furnishing them promptly with such observations
as may have been made.

The Fall Session, 1852, of the East Tennessee Medical
Society, will be held in Knoxville, commencing on the third
Thursday of October. Dr. B. B. Lenoir, will read the Pop-
ular Address. Physicians who can not possibly give their
personal attention, are requested to forward their essays, pa-
pers, and cases, to the Cor. Sec, at Knoxville.

It is a Baconian saying that, "reading makes a full man,
writing a correct man, and conversing a quick man," all of
which are qualities essential to the character of a good phy-
sician, and are more likely to be attained through Medical
Societies, than any other means, for association encourages,
if it does not demand reading, writing and conversation.

We most earnestly request practitioners of East Tennes-
see to give attention to the circular of the committee of the
American Medical Association, which has been forwarded
for publication, by the chairman, Dr. Sutton. In this age,
when every individual has an opportunity to communicate

21 G Editorial

something for the advancement of the cause of humanity,
we can not understand how practitioners can remain easy
in conscience, who do nothing in their profession except giv-
ing their personal attention to the daily demands of prac-
tice.

We understand that an individual of this county, who,
amongst other, and varied vocations, professes to be an
adept in the art of treating diseased bodies and souls, order-
ed to be administered to a child with Dysentery, one quart
of Sage tea holding in Solution Alum, to be repeated every
hour. The cfaild died in less than twelve hours after his vis-
it. Can any one tell whether the tea or the Dysentery
killed the child?

The recent session of the American Medical Association,
held in Richmond, Va., accomplished nothing which will be
felt by the great body of the profession. The members of
the Association, who were present during its sitting, of course
were individually improved, and returned to their routine of
labor with new impulses and fresh vigor. The next session
of the Association will be held in the city of New York, on
the first Tuesday of May, 1853. Legitimately, the sitting-
should be in St. Louis, Mo., but as too often is true, we pre-
sume, in this instance, might overcame right.

Read ! — Sir Astley Cooi»er, with a field of practice and
observation, probably larger than ever occupied by any one
other individual, wrote — "The life of man is too short to al-
low him, even with the greatest industry and zeal, and with
the most advantageous opportunities, to witness all the varie-
ties of accident or disease, and / should feel that I was not
properly discharging my duty, if I omitted to avail myself of
all the evidence which might be adduced by those on whose re*
spcctable testimony I depend."

Editorial. 217

We admire the spirit manifested in the following note
from a practitioner, of Monroe county, and are fully per-
suaded that people who are unhappily sick and confide
themselves to his care, will be eminently fortunate in the
selection of a physician.

May 10, 1852.

Sir : I see by the Southern Medical and Surgical Jour-
nal, that you have commenced the publication of a journal
— "The East Tennessee Record of Medicine and Surgery" —
and being desirous of its welfare, I do not know of a better
way to extend its circulation than to contribute my mite.
Send me the Record and I will remit the subscription —
which is not stated by the Southern Medical and Surgical
Journal — as I know the only way a journal can live, is by
prompt payment. Yours, &c.

Prof. J. B. Mitchell, as will be seen from our advertis-
ing pages, will devote more time, than heretofore, to making
chemical analyses. Provided with a supply of pure chem-
icals, and a good balance, he is prepared to analyse ores,
soils, mineral waters, and suspected poisons. We have
more than once been requested by farmers to know what
particular manure was applicable to particular fields.
Prof. Mitchell, at a small expense to the farmer, will tell
him whether lime, guano, or organic matter would be most
suitable to particular fields, by being furnished w T ith a sam-
ple of soil from the field to which the enquiry applies.

Amongst the many changes which have recently occurred,
in the arrangements of Medical Colleges, we are pleased to
learn that the Philadelphia College of Medicine has happily
secured the talents and energy of the polite and educated
editor of the Examiner, F. Gurney Smith, M. D. We ex-
pecthim to win fresh laurels in his new position.

218 Editorial.

We are pleased to record the fact that Prof. Benj. W.
Dudley, the Nestor of southern and western, if not of Amer-
ican chirurgeons, has consented, again to impart to pupils
his immense fund of surgical knowledge. The Kentucky
School of Medicine — or, more appropriately, perhaps, "The
Medical Department of Transylvania at Louisville" — will be
his field of labor. From our recollection of his mode of
teaching, and appreciation of his surgical precepts and prac-
tice, and general professional bearing, we feel that all who
hear his lectures are, in after-life, compelled to say, " 'twas
good for us to have been with him."

We most cordially thank the medical press of the coun-
try, for the very flattering reception they have given our
effort to establish a journal. And to the writers of the nu-
merous private letters of commendation and encouragement
with which we have been favored, we can now but make
acknowledgements, and promise continued energy and per-
severance.

Editorial 21

The following journals have been received in exchange, and may be con-
sulted by physicians residing, or temporarily, in Knoxville, by visiting the
room which has been appropriated as a Medical Reading Room, in the rear
of our office on Gay Street.

Several of the journals send to "The Record," and others to the address
of the Editor. We can not have too many copies of any number of our
exchanges ; but we do not, under present circumstances, care to have them
come to our personal address.

We defer to a future number copying the commendatory notices with
which we have been favored.

Publishers who desire, may convey their favors (not mailable) to us through
the houses of Wm. Goodrich & Co., 116 Market street, Philadelphia; P. D.
Gates, No. 31 Coenties Slip, N. York ; Allen & McCartee. Charleston, S. C.
Medical Reporter, Burlington, N. J.; Medical and Surgical Journal, Boston,
Mass.; Medical and Surgical Journal, St. Louis, Mo.; Transylvania Medi-
cal Journal, Louisville, Ky.; Examiner, Philadelphia, Pa.; Medical Jour-
nal, Nashville, Tenn.; Nelson's Northern Lancet, Plattsburg, N. Y.; Cana-
da Medical Journal. Montreal, Canada; Monthly Register, New Orleans,
La.; Dixon's Scalpel, New York; Sthesoscope, Richmond, Va.; Medical Jour-
nal. Charleston, S. C; Journal of Insanity, Utica, N. Y.; and we see our
bantling's name on the exchange list of the American Journal Medical Sci-
ences, Philadelphia, while the numbers still come to us as a subscriber. If
we can not receive it in any other way, we'll continue to pay for it ; because
we think the profession should support a national Journal, and from many
circumstances this one is entitled to that consideration ; albeit, more than
one communication in the last number smells more of advertising, than of
care for the interests of the profession. But we must confess that our ideas
of "relative duties" force us to the opinion that the Record, and not its ed-
itor should receive the Journal. /

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THE EAST TENNESSEE

RECORD OF MEDICINE AND SURGERY.

JANUARY, 1853.— No. 3.
ORIGINAL COMMUNICATIONS.

Art. I. — The Knoxville Epidemic of 1838, Communicated

by Dr. Frank A. Ramsey.

When a candidate for the doctorate I submitted to the ex-
amination of the Trustees and Medical Professors of Tran-
sylvania University, as an inaugural dissertation, a paper
on the epidemic which raged in Knoxville, Tenn., in 1838.

The material for the preparation of this paper had been
kindly furnished to me by Dr. James W. Paxton, an old, in-
telligent and highly esteemed practitioner, whose unwear-
ied exertions, and kind attentions in the laborious discharge
of professional duties, during the whole of the trying hours
of that awful visitation, are gratefully remembered by
many citizens of this community. The copious notes which
he furnished me, carried with them his views, and these of
course were impressed on my thesis. Men observe different-
ly, reason differently, and arrive at different conclusions,
from the same observations when personally made — and
hence the probability that the paper really contains more of
another's, than of the opinions of the avowed author. Thus
much in justice to the original observer, to myself, and for
the purpose of establishing the authenticity of the observa-
tions, which are now submitted to the Society, with a view
to their publication in its proceedings.

222 Ramsey on the Knoxville Epidemic.

It would hardly seem necessary to appologise for publish-
ing a history of an epidemical disease; but I deem it proper
to say, that I have been frequently asked by medical gen-
tlemen of distinction to acquaint them with the features of
the Knoxville visitation, and heretofore have been able only
to refer them to my written thesis. This was not always
convenient for reference, — and 1 conceive it to be my duty
to place the paper in archival relation with this Society, that
it may at any time be consulted.

It may not be out of place to state, that my thesis was in-
scribed to Prof. Benj. W. Dudley, as an evidence of the grat-
itude, which the members of my family are under, for his
having relieved a relative of a painful disease, by a skillful
surgical operation.

Knoxville is situated on the Holston river, in Knox coun-
ty, East Tennessee. From east to west it is spread over a
portion of two hills, a third commencing just at the west-
ern termination of the town. The east and west hills are
separated from the middle hill, on which is located the prin-
cipal portion of the town, by two creeks. Directly north of
the town, was a large fresh water pond, supplied by a spring,
containing fish, and filled with a kind of flag, which gave
the body of water the name of Flag pond ; while the river
forms the southern boundary of the town. On the creek
which runs through the town, on the east, there were three
mill-ponds, within the space of half a mile. The upper,
known as the "White mill-pond," extended north and north-
east for more than a mile. On the creek, at the western ter-
mination of the town, known as second creek, there were
two large mill-ponds. Thus it will be observed, the town
was almost surrounded by water, which was for the most
part stagnant, and filled with decaying vegetable matter,
during the remarkably dry summer of 1838.

The creeks have a very considerable fall, and ordinarily
run with rapidity, and the river is generally navigable for
small class steamboats for at least ten months of the year.

Ramsey on the Knoxville Epidemic. 223

But during the summer of 1838, so very little rain fell that
the creeks scarcely ran, — collected in puddles between the
dams, and the water in the ponds was stagnant, and filled
with aquatic plants, animalculee and debris from the saw
and grist mills, and tan yards, and exhaled, especially to-
wards evening, a disagreeable odor ; while the river-bed
was almost dry, and contained an unusual quantity of
long moss, which lay on the surface of the water exposed to
the full rays of the sun, and which emitted when disturbed,
as it frequently was by hogs in search of muscles, a foetid
smell. At the northern margin of the town is a grave-yard,
which has been used for more than thirty years, and is con-
sequently very full. Over this, at night time, phosphores-
cent appearances were observed — clearly indicative of a
noisome influence emanating from that location and its
circumstances.

About the year 1834, Intermittent Fever was noticed as
being much more common than it had been, — our oldest in-
habitants not remembering it to have occurred for very
many years previous, to an extent worthy of being remarked.
From 1834 this affection continued to prevail, acquiring an
intensity and persistency with its continued prevalence,
with occasional cases of Remittent Fever, some of which
were almost intractable, and some fatal, until the spring
preceding the epidemic, few if any cases of Intermittent Fe-
ver were observed.

The epidemical sickness began in June, 1838, in an in-
crease of the number of sufferers, and of the severity ol the
bowel complaint in children. When the sickness became
more prevalent and exhibited more decided characteristics,
bowel complaints seemed to disappear, or to merge in the
sickness. It soon appeared in all parts of the town, no quar-
ter being exempt, and increasing fearfully in the number
of its victims, until it reached its acme in August, which it
sustained until towards the close of September,when it com-
menced its declension, and finally disappeared coincidently

224 Ramsey on the Knoxville Epidemic.

with the advent of cold, changeable weather,\vhich occurred
during the latter part of October.

Few persons wholly escaped the influence of the epidem-
ical cause, during its prevalence. Their color was bad,
tongue more or less coated, and experiencing great physical
languor ; under these circumstances the least irregularity in
diet or habit insured to them an attack.

In many cases the attack was induced by indulging in the
use of fruit. Indeed some thought the peaches of that sea-
son possessed a poisonous quality ; but it is evident that the
essential cause was the weakness or irritability of the stom-
ach and digestive organs, rather than any unusual qualities
of the peaches.

When the sickness became prevalent, many left town,
and removed to the country, yet but few profited by the
change. The fatigue, trouble and anxiety of moving, to-
gether with the fear of the disease, occasioned many to sick-
en, and the wants of the comforts of home, and the absence
of prompt and proper medical aid, rendered their condition
worse than if they had remained in town. This fact was
felt so severely by the most of those who had removed, that
they hastened to return to their own homes, from the pure
country air, to the close and contaminated atmosphere from
which they had fled.

The topographical sketch which has been given of Knox-
ville, very strongly sustains the doctrine of malaria, evolved
from stagnant water and decaying matter, originating dis-
ease ; What marsh miasm, or malaria is, I believe is not
known ; we speak of it from its effects, without any knowl-
edge of what it is in itself! That heat and moisture in due
proportions, and acting on decaying organic matter, produ-
ces or evolves a something or an influence, injurious and
productive of disease was known in olden times, and mod-
ern science has made no new revelations respecting the
essential character of this productive cause of sickness.

Ramsey on the Knoxville Epidemic, 225

The mode in which malaria — which we have reason to
believe, in its various modifications, is the cause of most of
the diseases incident to the human family — invades and
acts on the human organisation, vitiating its functions, and
sapping its vitality, might be discussed in this connection ,
but the question is too pregnant of hypothesis, has too much
capacity for the indulgence of the imagination, to be intro-
duced into a paper professing to be purely historical.

The most common form of Fever which the epidemical
sickness assumed was the Continued, though even this form
in very many cases, had an intensity of manifestations to-
wards evening, which it did not wear during the mornings.
Indeed, it not unfrequently assumed something of the Re-
mittent element, being most severe on alternate days, con-
stituting the tertian of the old masters of physic ; but gen-
erally it preserved its own characteristics throughout an
attack — a gradual increase of the intensity of Fever from
the commencement.

There were cases of Intermittent and Remittent, and very
rarely of Congestive. The sickness began with but little
chilliness, and but slight rigors, and the sensations confined,
for the most part, to the spine. A more considerable chili
was generally followed by a Remittent, while a distinctly
formed rigor, of some duration, ushered in an Intermittent.
Although in the Remittent form, for a few revolutions, the
Fever was continuous, the preceding paroxysm not disap-
pearing until the accession of the next, it was distinguisha-
ble from the essential continuous form, itself gradually aug-
menting in intensity, by the new accession, or every succeed-
ing paroxysm being marked more or less distinctly by a
chilliness.

The skin was more or less sallow, hot and dry, and seldom
inclined to moisture, until towards the disappearance of the
disease.

In some cases the head-ache was severe, and the mind
confused, and unable to concentrate itself on any subject.

226 Ramsey on the Knoxville Epidemic.

In some few cases the head-ache had almost the appear-
ance of Phrenitis, in other* of Apoplexy. One lady, who
sickened alter much fatigue and grief, had a fit, which was
succeeded by a comatose insensibility — so positive as to
render her wholly unconscious of the impressions of
sinipisms and blisters. She finally recovered, but her
tongue for weeks was so paralysed that she could not ar-
ticulate distinctly, and a much longer time passed before
she regained her usual vigor of mind. But these were the
exceptions, for commonly the head suffered but little de-
rangement.

In some young persons of a phthisical tendency, the la-
tency was destroyed, and tubercle was deposited on the
lungs, and rapidly passed into suppuration, soon carried the
subjects off with confirmed Phthises Pulmonalis. These pa-
tients appeared to recover very imperfectly from the imme-
diate attack of the epidemical sickness, — were feeble, had
cough, and complained of uneasiness or pain of the chest.
The cough became more intense and distressing on every
exposure or change of weal her, and in a short time was ac-
companied with purilent expectoration, under which they
sank, if not sooner, during the ensuing winter. Pertussis
was prevailing to some extent at the time of this epidemic's
visitation ; and these combined in the same persons were
particularly fatal. The irritation existing in Hooping-cough,
seemed to solicit the force of the epidemical attack to the
lungs, inducing a very malignant Bronchitis. Some sank
under the inflammatory action, thus established ; fits ensued
in other cases, apparently induced by ineffectual efforts to
cough up the tough mucous, which clogged up the lungs.
In one family, the children of which had Hooping-cough,
when they sickened with the epidemical disease, such was the
redness of the face and mottled appearance of the neck and
breast, that the patients were considered b} r their friends as
having measles, and had forced upon them hot toddy, to drive
out the rash. When professional aid was called, the resorts

Ramsey on the Knoxville Epidemic, 227

adopted, proved unavailing in producing relief, and the chil-
dren died.

Most or all of the cases were complicated with organic
involvement — most commonly the liver, stomach, and bow-
els manifesting the impression of the morbific cause, or the
degree of disorder occasioned by the febrile action which
had been established. Often the biliary secretion was
almost entirely suspended, and always, it was much di-
minished in quantity, and depraved in quality, and some-
times there was pain and a sense of uneasiness in the re-
gion of the biliary gland.

The stomach was frequently irritated, with a feeling of
fullness at the epigastrum, and tenderness on pressure.
And the bowels were also frequently tender, seemingly dis-
tended or full, and imparted a sensation of great warmth to
the hand — indeed hot.

Many had black- vomit,, and hemorrhage from the bowels
occasionally occurred, and sometimes from the nose and
mouth ; and very commonly the body after death assumed
a lemon yellow color. Had these cases occurred on the
southern sea-board, at Charleston or New Orleans, they
would have been, without doubt, considered as cases of Yel-
low Fever. And I am assured that more than one of the
practitioners, then residing in Knoxville, and engaged in
combatting this fell destroyer, regarded themselves as in
the midst of Yellow Fever.

The duration of the attacks varied considerably ; some
cases run a course of seven or eight days, but more com-
monly, twelve, fourteen, and not unfrequently twenty-one
days were passed, before convalesence was decisively evi-
denced.

The head-ache, flushed face, heat of the skin, and especi-
ally the hardness of the pulse, with the marked tendency to
local complications, indicated the inflammatory character
of the sickness and clearly pointed to the necessity of a de-
pleting treatment.

228 Ramsey on the Knoxville Epidemic.

Bleeding, repeated according to the nature of the pulse
and the general strength of the patient ; Calomel, to unlock
the secretions, and act as a cathartic upon the first passages;
cold drinks, cold externally, and blisters, sinapisms, etc., in
cases of local irritation, were the cardinal remedies.

Many cases required repeated bleedings, ad deb'quium.
Towards the close of the season, bleeding was not required
to the same extent as at an earlier period of the epidemic ;
although at a very late period a few cases occurred, which
called for repeated opening of a vein, one or two bleedings
at the commencement of the attack not proving beneficial.
Ordinarily, when depletion was freely and judiciously used,
at an early period of an attack, the local determinations dis-
appeared, or were more manageable, and others less apt to
arise during the progress of the disease.

The torpid state of the liver, and the depraved condition
of its secretion, justified the employment of some powerful
agent to rouse the gland into action, and restore its secretion
to a healthy condition. For this purpose Calomel was giv-
en freely until the secretions were all unlocked, and then de-
termined to the bowels by the impression of some suitable
purgative agent. If there was no tenderness of the bowels,
Jalap acted well, otherwise Castor Oil, or other mild laxa-
tive means produced better results. After the secretions were
well restored, an occasional dose of Calomel was necessary
to retain the condition which had been attained by its use.
Laxatives were useful throughout an attack ; but when any
tenderness of the abdomen existed, enemata were prefera-
bly.

Local determinations were treated according to their

seat, character, and the condition of the patient. To the
head ice, and ice water, and cold lotions were applied, and
if necessary these were assisted by cupping, and blisters to
the neck, behind the ears, or on the temples. When there
was soreness or pain, about the liver or stomach, blisters
were particularly useful. When the bowels were very hot,
evaporating applications were used, in connection with cold

Ramsey on the Knoxville Epidemic. 229

or ice water injections, with very happy effect. The cold
injections, besides assisting in abating the excessive heat,
also tended to keep the bowels soluble. Emollient poulti-
ces were sometimes used to remove soreness, but where there
was considerable irritation, sinapisms and blisters were re-
quired.

In the last, or sinking stage, excitants or stimulants were
used, internally and externally ; but when the vital powers
fairly gave way, so as to demand the use of stimulants, there
was little hope of recovery.

Every form required much the same treatment. In treat-
ing remittent cases, distinct intermissions were procured,
when Quinine was used to prevent the recurrence of the
paroxysm. In both remittents and intermittents, emetics
were successfully administered, while they were not bene-
ficial in the continued form of attack. When given in
the commencement of the cold stage of the intermittents,
the vomiting broke the Ague, induced the hot stage, which
was generally under these circumstances, soon superseded
by sweating — thus shortening much a paroxysm, and ren-
dering an intermission clear and distinct. And then five or
six grains of Quinine, if given every hour or two in grain
doses, seldom failed to prevent the accession of a subsequent
paroxysm.

Convalescence was generally slow; relapses not un fre-
quent , and many were troubled with Ague and Fever the
succeeding winter and spring. Tonic bittters, gentle pur-
gatives, with a Calomel or Blue pill occasionally, when bil-
iary secretion became rather torpid, tended much to invig-
orate the system and enable it to resist the attack of Chills.

Out of a population little exceeding two thousand, more
than one hundred deaths occurred. Many perished soiely
from the want of proper professional attention, and absence
of the necessary care of a good nurse. Very many families
were nearly all unnerved and prostrate — and those who
were up, were unable to give the sick the attention and as-
sistance their safety absolutely required. Assistance could

230 Morris on Deafness and Diseases of the Ear.

not be obtained from neighbors — all were attending, when
able, their own sick at home. The business houses were
closed, and the streets deserted ; the town was in fact one
general hospital, and the adjoining country was far from be-
ing healthy. The country people could not be induced to
come in and act as nurses; seldom, indeed, would they come
to supply marketing. All things conspired to render the
number of sick on each physician's care too great lor that
close attention which the nature of the disease demanded.

Rumor reported the malignancy of the disease and the
danger of visiting the town, even beyond the truth. Trav-
elers were afraid to ride through the streets, many going
miles out of their way, to get around town; and others went
through the town under whip and spur, with their nostrils
plugged with Assafostida, Camphor, or some other aromatic
with presumed prophylactic virtue.

Such were the circumstances — the sick with but little or
no aid and assistance, destitute of the necessary attention to
cleanliness, so essential to their comfort and even safety, and
terror universally prevailing — that medical advice could do
but little good except cheering the drooping spirits, of the
sick, and soothing the anguish of expiring nature.

Art. II. — An Appeal and some Hints to the Medical Profes-
sion, on the subject of Deafness and Diseases of the Ear,
communicated by O. W. Morris, Principal of the Tennes-
see Institution for the Deaf and Dumb, Knoxville, Tenn.
We have been much puzzled, if not pained, for some
length of time, and more especially within a short time past,
at the want of interest exhibited by the Medical Profession
in the United States, as evidenced by their publications, on
the causes and cure of deafness. There is hardly any other
ill that flesh is heir to, but has been investigated, and the
profession have called to their aid all the helps that ingenu-
ity and art could devise, both as relates to the causes and
methods of cure. Almost every organ of the human body

Morris on Deafness and Diseases of the Ear. 231

has been made the subject of repeated experiments ; the ear
has, however, been left as either hopeless, or not susceptible
of any improvement, although it is one of the most impor-
tant organs of the body, and an inlet of some of the most
pleasing emotions to which the human frame is susceptible.
This apathy surely can not arise from indifference to its im-
portance, nor from incapacity to investigate, nor can it be
from an implicit faith in the theories and investigations of
the profession on the other side of the Atlantic ; for the eye
is equally delicate, and treatise after treatise is written upon
its structure, its diseases, and their treatment. Does the
profession in this country conclude that it is of little impor-
tance whether the deaf person can be restored to hearing or
not? Is not the "concord of sweet sounds" as inviting, as
soothing, and as important to an individual, as the appear-
ance of nature ? And are not the tissues composing the or-
gans of hearing dependent upon corresponding principles
to those that pertain to vision, taste, &c. Why then, do we
search the pages of Medical Science, published by our coun-
trymen, for information on the subject of deafness, and find
only a very few short notices of some experiments or some
cures ? Are there no Deleaus or Itards here to devote some
portion of their time and much of their ingenuity and ener-
gy of mind to the alleviation of the state of the unfortunate
deaf person ? Consider the situation of the deaf and dumb
child, alone among his fellows and come to his relief.

We feel pity for the unenlightened pagan and benighted
heathen, while their condition, sad as it is, will not compare
with the uninstructed deaf mute. In the language of an el-
oquent philanthropist — "The former have some traditionary
knowledge of a Supreme Being, and enjoy the pleasure of
social intercourse ; but the latter is a living and moving sol-
itude in creation ; his ears hear no sound and his tongue ar-
ticulates no words ; to him there is no speech, nor language,
even in the mart of the world's commerce, the circle of so-
cial intercourse, or the solemn assembly of the church; the
gentle whisper of affection, the melody of nature, and the

232 Morris on Deafness and Diseases of the Ear.

loud thunder of the elements, are to him alike unknown ; and
he stands unmoved, even at that mighty noise, at which the
earth and the depths are troubled. A stranger and a bar-
barian among his fellow-men, he is isolated within his own
individuality, and though he labors to facilitate their inter-
course with his mind, he can not, by any effort of his own
without our aid, surmount the obstacles in his way. How
great soever his capabilities may be, his imprisoned mind
remains dark and unpolished, like a pearl of great price and
brilliancy buried in the earth."

A medical writer in Europe, some years since, depicted
their condition in sad, yet true colors. He said : "Fearful
indeed is the gloom of that state which is cheered by no
prospect of release ; tremendous that awful foreboding of
return into nothingness, which is often observed to bear
down all the mind, wither the spirits and blacken the sweet
vision of life among the uneducated deaf and dumb. Hence
that utter and overwhelming dejection which oppresses
them in sickness ; hence that instinctive and inconsolable
terror which we have often seen in the deaf and dumb, at
the approach, or even the idea of death. There is no reme-
dy for this in the pleasures of the world, for these are then
just fading from his view ; there is no balm for this in the
attention of friends, for he is then, as he thinks, on the point
of an eternal separation; there is no medicine for this in
hope, for with him all hope terminates in the grave."

Such being their situation when blessed with health, or
when on the bed of sickness with their friends around them,
it is. incumbent upon us that we strive to alleviate their con-
dition as much as is in our power, — and upon whom does the
duty seem to devolve so especially as upon the Medical Pro-
fession ? for the study of Medicine embraces not only the
structure of and laws which govern the economy of organ-
ised beings, and particularly that of man, but also the histo-
ry and properties of the agents which are operative in pro-
ducing disease, and in restoring and preserving health. In
a word, it comprehends the phenomena of life and whatev-

Morris on Deafness and Diseases of the Ear. 233

er tends to affect the mind and body ; therefore it may be
said to extend over a wider field of inquiry than any other
department ot human knowledge.

Among the public duties attached to this profession, a
distinguished professor in one of the oldest medical institu-
tions of our country enumerates the following. "An inqui-
ry into the immediate and diversified effects of climate ;
the quality of the water used in diet, &c; the properties and
effects of certain articles of food ; the best mode of preserv-
ing the health of persons employed in manufactories, &c; a
knowledge of the principles of Hygeine, &c; the origin, dif-
fusion and prophylactics of pestilential diseases and epi-
demics; the influence on health of intoxicating drinks ; dis-
eases peculiar to the army and navy; medical jurisprudence,
— and as medical teachers."

The Medical Profession has an important influence upon
education, agriculture, science, temperance and social hap-
piness among our fellow-citizens. The physician's influence
begins in the nursery, his power for good or evil is conse-
quently great. Sometimes a few hints dropped by him in
conversation with the parents will lead to the education of
the child ; and many times a taste for literature and science
is commenced and fostered in the young mind, that in after
life produces abundant results ; the fireside joys are in-
creased ; the domestic circle enlivened and rendered happy,
by the exclusion of the vices of the vulgar, and the tone of
feeling in society is elevated and enlarged ; and often libra-
ries formed, institutions of learning and benevolence com-
menced, lectures given, and literary and scientific societies
formed through the influence of the enlightened physician,
yet these are not its legitimate objects ; its ostensible and
most important object is the restoration and preservation of
health; for a very large portion, we might say all, of society
are dependent upon medical skill for their usefulness, and
in some instances, for their lives.

Dr. Stevens, President of the College of Physicians and
Surgeons in the city of New York, speaking of the Medical

234 Morris on Deafness and Diseases of the Ear.

Profession says: "The whole of human life, with all its
changes, whether progressive or occasional, is the subject
of our meditation and the object of our labor and care. Man
thus becomes the study of our profession ; his physical for-
mation, his intellectual powers, the effects of the mys-
terious connection in his being between mind and matter;
the inscrutable nature of his principle of life ; his adapta-
tion to social and domestic relations ; his moral tenden-
cies and his religious capacities; the double nature, which
makes him, while a child of earth, an heir of immortality,
— ail these belong to that study and contemplation of man
to which our daily vocation leads us. And while the sub-
ject of the studies and labors of our profession is the noblest
of God's creation on earth, the preservation of his life and
health, his morals and happiness, its one great object, not
less is it distinguished by the vast extent of its collateral re-
lations, and the mighty and immense range of agencies and
instrumentalities it employs. It contemplates the qualities
and conditions of all in animate substances, of all things, im-
material, intangible, imponderable."

Again; Dr. Stevens says : "No one can be qualified to take
care of the sick who does not add to his reading and oral
instruction a practical knowledge of the structure of the
human body; neither experience, nor reading, nor oral in-
struction alone are sufficient, but all need to be combined
with observation." And again : "The Medical Profession
may justly claim for itself a degree of influence second to
none of the learned professions. Surely then, they who
hold such relations to society, as physicians do, should be
learned, discreet and wise ; trained by liberal studies and by
practical examples to be ever true to the cause of humanity;
elevated by education, as by education alone they can be
elevated, to rise above all that is sensual and sordid."

If then, such be the standing, and such the influence
which the profession enjoy, they will not be backward in
doing all that is in their power to alleviate the misery of the
deaf, who are calling upon them, by every principle of be-

Morris on Deafness and Diseases of the Ear. 235

nevolence, and every feeling of humanity. Their number,
in comparison with that of other diseased, may be small, yet
that is no reason why they should be neglected, or their
claims overlooked. It is true some instances of devotion
to their cause can be found, and they shine forth bright ex-
amples for others to follow.

The number of deaf and dumb alone, and they are not the
only deaf ones who call for assistance from the healing art, is
computed at 250,000 in the world, in the United States it
is 9,614, according to the last census, which falls short of the
true number, and a large proportion of these have been, or
might have been proper subjects for the exercise of scientific
practice. According to an estimate made at the New York
Institution for the Deaf and Dumb, in the yearl 836, there had
been 520 pupils admitted into the institutions in that state;
of these 202 had lost their hearing by sickness and acci-
dents. In 115 cases it was doubtful what was the cause, or
whether they were congenital ; and 203 cases were consid-
ered congenital. Of the congenital, some had malforma-
tion of the organs, which might possibly have been reme-
died by science. Of the 202, without doubt, many might
have been restored to their hearing if attended to properly,
as to time and means ; and of the 115 doubtful, it can hard-
ly be expected but that some might have been cured.

Another estimate, made at the same time, of the pupils
who had been admitted into all the then known institutions,
who had lost their hearing after birth, gave 787. Of these
there were 398 from diseases and accidents unknown, leav-
ing 389 the causes of which were known. Of this number
143 had lost their hearing by Fevers of different kinds ; 188
by Convulsions, Colds, Measles and other eruptive diseases,
leaving only 58 for other causes, as Ulcers, Injuries, &c.
An estimate was made at the American Asylum at

Hartford, Conn., in 1847, in which it was found that of 200
pupils,110 were born deaf, and 4 unknown ; of the remain-
ing 86,48 had lost their hearing by Fevers, and the other
38 by Ulcers, Whooping-cough, Inflammation, Dropsy,
Scrofula, &c., &c.

230 Morris on Deafness and Diseases of the Ear.

This is enough to show that a probability of cure exists
even among the deaf and dumb who are among us, and
some of whom we have known ; while among those report-
ed as congenital there must be many who might have been
cured had sufficient knowledge of their cases and the prop-
er means of cure existed. Is there not, then, an induce-
ment for young men in this country to study more carefully
and scientifically the organization of these parts and the
methods of cure that they may relieve the distressed, and
that they may not be behind some of their brethren on the
other side of the Atlantic ? — two of whom have been already
named, who devoted a large portion of their lives to inves-
tigating the causes of deafness and its probable cure among
the inmates of the Royal Institution at Paris. They suc-
ceeded in restoring a very few to their hearing, but as they
did not succeed on others by the same methods, they seem-
ed to give up the cause. Their methods were various,
such as perforating the typanum, using Moxh, &c.

A few others have awaked from their lethargy and spent
much time in experimenting and theorising; some of them
have been successful and their patients have gone forth im-
proved in health and the means of enjoyment. Some have
made examinations of the ear, its parts, and the results of
disease, a few of which follow.

Dr. Passavant, of Frankfort, gives us an account of the
anatomical and pathological appearances of the ear and its
appendages, in a number of persons who died of Typhus
Fever. He says the dura mater showed upon its surface
an excess of blood, and its substance was thoroughly inject-
ed ; the membrana tympani had lost its brightness and
become more or less reddened and swollen ; its epithelial
layer easily separated as a dirty white pellicle, with the
membrane beneath greatly thickened, together with the li-
ning membrane of the meatus, the inner half of which wa s
much injected. Within the cavity of the tympanum he
found a tough, thready mucus, sometimes only a few vesi-
cles, sometimes occupying the walls, and sometimes filling

Morris on Deafness and Diseases of the Ear. 237

the entire cavity. He detected a slight injection in some
portions of the lining of the labyrinth, but no change in its
contents.

Dr. Morrell, of New York, remarks that in 25 cases of
Scarlatina, wherein deafness had been a common symptom,
he found afterdeath that the lining membrane of the Eusta-
chian tube was thickened or softened, (probably red during
life,) and covered with a thin, glairy secretion, in which
floated a great number of ash-colored shreds, and that this
secretion sometimes extended into the tympanum. The
membranes of the external meatus were covered with
minute points, from which issued a sero-purulent secre-
tion, instead of wax. In fifteen cases of Measles, where
symptoms of deafness also occurred, the membranes of the
Eustachian tube and the tympanum exhibited traces of red
vessels ramifying in all directions, together with a remark-
able dryness, as if the mucous secretion had been interrupt-
ed for some time. The membrane of the external meatus
showed that the secretion of wax had been interrupted also.
He succeeded in curing some similar cases by persevering,
in some cases, for months.

Mr. Toynbee, Surgeon to the St. George's and St. James'
dispensary, England, in his remarks upon the pathology of
diseases of the ear, says: "Of the cavity of the tympanum,
the most common mischief is the thickening of the mucous
membrane lining it, in some instances so as to almost fill it
up." He says, also, "that its most common contents are mu-
cus, purulent discharges and scrofulous matter. Bands of
adhesion are also of frequent occurrence, and in some cases,
anchylosis of the stapes to the margin of the fenestra ovalis.
Very few cases of disease in the Eustachian tube, or in the
cavities which contain the expansion of the auditory nerve,
or their contents occur." He gives no account of the cura-
tive measures that should be employed, as the various af-
fections might seem to indicate, but urges early, judicious
c

238 Morris on Deafness and Diseases of the Ear.

treatment, pursued with careful perseverance, leaving that
treatment to be found out hereafter.

Dr. Schmalze, of Dresden, after an examination of 4000
cases of disease of the ear, in a practice of twenty years,
classifies these diseases, and gives illustrative cases of the
treatment and the successful results. He places them in
three general divisions, which are sub-divided into smaller,
and these into still more particular divisions.

His first division is Inflammation. This is divided into
1st. The external ear; 2d. The internal ear ; 3d. The inner
ear. Inflammation affecting these may be pure, (erythe-
matous and phlegmonous,) or mixed, (erysipelatous, ca-
tarrhal, rheumatic, gouty, scrofulous, &c.)

The second division is Mechanical. It is divided into
1st. Congenital m*|Jformation ; 2d. Solutions of continuity;
3d. Impeded conduction of sound.

The third division is Nervous diseases. It is divided into
1st. Irritation ot nerves of hearing ; 2d. Paralysis of nerves
of hearing.

As this is the most important division, he has subdivided
each division into more particular classes, as the first, into
those diseases connected with the auditory nerve, of which
there are five varieties, and those of the auricular branch-
es of the fifth nerve, causing only Otalgia, either mild or vi-
olent in its character. The second is sub-divided into
twelve classes.

1. Congenital and inherited.

2. Senile.

3. .Degeneration of nerve of hearing.

4. Violent noises.

5. Intense frost.

6. Mechanical concussion by blows, falls, &c.

7. Depressing emotions.

8. Typhus and Nervous Fever.

9. Apoplexy, Convulsions, pressure on the brain, &c.

10. Determination of blood to the head.

11. Anaemia from Hemorrhage, Onanism, &c.

Morris on Deafness and Diseases of the Ear. 239

12. Exanthemata, especially when they have a nervous
character.

He closes his remarks with a description of the methods
of performing aural surgery and the instruments employed,
which are similar to those of other surgeons. Probably his
work is the best compendium of diseases of the ear yet
published.

Dr. Kramer, of Berlin, who devoted many years to the
investigation and methods of cure of diseases of the ear,
and who carefully examined and noted down 3700 cases,
comes to the conclusion that no satisfactory diagnosis or
treatment of diseases of the ear can be conducted without
an attentive study of the objective, and not an implicit de-
pendence upon the subjective symptoms. Another conclu-
sion is, the failure of cure from the remarkable tendency
which diseases of various portions of the auditory appara-
tus have to continue limited to those portions, so that, even
years afterwards, the more essential parts may remain quite
uninjured, and hearing be at once restored by the removal
of the intervening ailment. He therefore depends upon lo-
cal, and argues the insufficiency of general treatment, but
urges the necessity of searching carefully and diligently for
the part affected.

He gives the statistical results of each species of disease,
as he classifies them, which are, that inflammatory diseases
of the meatus have occurred 281 times out of 2000 cases,
and in some instances the disease was of years standing.
In this class he urges the careful use of the speculum.

Acute Inflammation of the membrana tympani occurred
in 45 cases out of 2000 ; while he found chronic Inflamma-
tion in every fifth case. Perforation was observed in 179
cases out of 379, and of different sizes, from the size of a
needle point to that of a bean; two-thirds of these cases oc-
curred during the first ten years of life, which are those
best adapted to its cure. He considers a discharge from
the outer ear as a mere symptom of disease, and not as a
form, as it had been treated by some physicians. He treats

240 Morris on Deafness and Diseases of the Ear,

diseases of the tympanum as inflammation of the mucous
membrane, which may be communicated to the bones and
cause their destruction. He relies on the catheter through
the Eustachian tube for the investigation of this kind of dis-
ease, having found only two cases in which there was an
obliteration of this tube.

He says that an investigation of diseases of the internal
ear are of the most difficult character, from the absence of
any ordinary means, but that much may be gathered by a
careful examination of the tympanum with the speculum in
a strong sun-light. If the tympanum be in a healthy con-
dition the membrane appears entirely colorless, shining and
diaphanous, having a well marked concavity externally.
If it be in an unhealthy state, the membrane appears inflam-
ed, reddened, thickened, degenerated, swollen or indurated,
and putting on the appearances consequent upon an inflam-
mation.

In his chapter on Nervous Inflammation, he remarks, that
it may come on gradually and not be detected for some
time, especially where only one ear is affected. The mea-
tus frequently contains dry, crumbling wax, disappearing
after some time and followed by white, dry squamaB, while
it puts on a parchment like appearance, both of the surface
of the meatus, and the membrana tympani. This is ac-
companied by unpleasant sensations in the head, annoying
the patient much in proportion to the deafness. The diag-
nosis is mostly of a negative character. This is the most
frequent of any of the diseases to which the ear is subject,
occurring in 1028 cases out of 2000: it is also one of the
most lasting, being connected with the auditory nerve. In
the treatment of this form of disease, he strives, first, to pro-
tect the ear from injurious impressions, produced by loud
sounds — either hard, shrill voices, or instruments — so as to
subdue the morbid irratibility of the auditory nerve, in con-
nection with mild vapors, through the Eustachian tube, as
of water, mucilage or thin gruel, in which is a minute por-

Morris on Deafness and Diseases of the Ear. 241

tion of Ext. Hyoscy., of from two to four weeks continuance.

His statistical tables are the results of fifteen years care-
ful observation, and to show the care which he took, an
abstract of the tables will be inserted ; they will also serve
as a guide to others.

I. — General view of Diseases of the Ear.

Of 2000 cases, 5 were cases of disease of the auricle; 281,
of the auditory passage ; 442, of the membrana tympani ;
]98 of the middle ear: 1028, of nervous deafness; and 46,
of deaf dumbness. What the particular characteristics of
the latter class are, he does not say.

II. — Of the relative frequency of Diseases of the Ear in the

two sexes.

Of the 2000, 1274, were males and and 726 females. Of
the 5, two were males and three females ; of the 281, 207
were males and 74 females ; of the 442, 311 were males and
131 females; of the 198, 141 were males and 57 females;
of the 1028, 581 were males and 447 females; and of the
46, 32 were males and 14 females.

III. — Of unilateral and bilateral affections of the Ear.

Of 2000, 361 were affected only in one ear, and 1639 in
both ears ; of the 361 cases of unilateral disease, the left
ear was affected in 167, the right in 194 cases. Of the 5,
(in table I.) 2 were affected in the left ear alone, 1 in the
right, and two in both ears; of the 281, the right ear was af-
fected in 62, the left in 54, and both in 165 ; of the 442, the
membrana tympani of the right ear was affected in 22,
the left in 21, and both in 2 cases; of the 1028, 44 were uni-
lateral, and 984 bilateral cases.

IV. — Of Tinnitus Aurium.

Of the 2000, tinnitus occurred in 1267. All the deaf and
dumb were free from tinnitus.

V. — States of the Membrana Tympani in Chronic inflam-
mation of it.

Of the 397 cases of chronic inflammation, both ears were
affected in 279, and one ear only in 118; there were thus
676 individual tympanic membranes affected. In 118 of

242 Morris on Deafness and Diseases of the Ear.

these cases there was neither polypi nor perforation ; in 217,
there were perforations ; in 99, polypi ; and in 37, both per-
ioration and polypi.
VI. — Simultaneous occurrence of several diseases of the ear.

Of the 2000, 38 cases were affectei with more than one
disease in one and the same ear ; and 6Q cases in which the
two ears of the same person were affected with two differ-
ent diseases.

VII. — The situation and mode of life of the 'patients.

It is not necessary to mention any thing, as no numbers
are given.

VIII. — The country and residence of the patients.

(Same as above.)

IX. — The age at which the patients became affected.

Of the 2000, 504 were in the first ten years of life, and of
these. 241 were cases of chronic inflammation of the mem-
brana tympani. In this table Dr. Kramer states that accu-
mulation of wax in the auditory passage occurred most fre-
quently between the ages of 20 and 40; Catarrhal inflam-
mation of the same membrane at about 20 ; Caries of the
same, before 10; Phlegmonous inflammation, about 20;
Acute inflammation of the membrana tympani between 20
and 40 ; Chronic inflammation, in the first 10 years, and
mostly in the first two years of life ; Muculent obstruction
of the tympanic cavity, within the first ten years also.
What other time so propitious for the cure of deafness ?
X. — At what age they first consulted Dr. Kramer.

This corresponds with the time in table IX.

Xlf — Duration of the diseases at the time of consultation.

Of the 2000, 164 had been affected less than four weeks,
and 1650 for a year or more.

XII. — The different distances at which they heard the ticking

of a watch.

The object of this is to measure the power of hearing.
Of the 1028 cases, 214 could not hear at all ; 77 heard with
the left ear, and 74 with the right only ; 217 ears heard the
watch at once ; 339 at the distance of an inch ; and 595 at

Morris on Deafness and Diseases of the Ear. 243

the distance of a foot. The result of from three to six
months treatment was an increase of the hearing distance
from one inch to one foot, and from one foot to three feet.
In the others he makes the increase in hearing distance the
evidence of the progress of cure.

XIII. — In Chronic inflammation with and without perforation,
how far the ticking of a watch heard.

In Chronic inflammation with perforation, there were
305 affected ears, of which 50 were totally deaf; 80, could
hear a distance of one inch ; 113, one foot ; 50, three feet ;
9, more than three feet ; and three, undeterminate. In
Chronic inflammation without perforation, there were 359
affected ears, of which 42 were totally deaf; 88, could
hear one inch ; 148, one foot ; 51, three feet ; 19, more than
three feet ; and 11, undeterminate. From his observations
he concludes, that it is of little advantage to perforate the
tympanum.

XIV. — The patients affected with nervous deafness so that
they no longer heard the watch, were aged as follows.

Of 214 cases, 109 who could not hear the watch with ei-
ther ear and 71 who could hear with one ear, were below
40 years of age, and many of the others had been deaf from
early life.

XV. — Those who had other diseases besides those of the ear
at the time of consultation.

More than four fifths w r ere free from other diseases, the
other fifth had a complication of them.

Of these complications, there were 26 eases where inflam-
mation of the mucous membrane combined with Scrofula ;
and 18, with Catarrh; one case where Vertigo was com-
bined with an accumulation of wax ; 3 with Polypus ; and
7 with nervous deafness. There was one case in which
Hemorrhoids and nervous deafness were combined. One
case where Phthisis was combined with Caries of the mid-
dle ear, and 4 with Phthisis and nervous deafness.
XVI. — Causes of diseases of the ear.

In 1109 cases, the causes were not known. Cold is the

244 Morris on Deafness and Diseases of the Ear.

most common cause. The Exanthemata and other diseases
of the skin were frequent causes. Fevers in some cases.
Blows on the ear in three cases. Injury to the head and
spine. Disease of the brain with convulsions in infants.
Great noise, sorrow, toothache, and hemorrhage were some-
times causes.

XVII. — Perforation of the membrana tympani after Scarlet
Fever, Measles, Cold and Small Pox.
There were 81 cases on both sides after Scarlet Fever ;
29, ^ifter Measles; 12, after Small Pox; and 28 after Cold.

XVIII. — The insults of his treatment.
These are enumerated under four divisions.

1. The unconditionally curable.

2. The conditionally curable.

3. Those conditionally capable of amelioration only.

4. The unconditionally incurable.

Of the first division he enumerates 309 cases, though un-
der some of his sub-divisions there must have been some
cures not enumerated. Of the second division, 1008 vvere
cured and a number improved. In the third and fourth di-
visions he gives no numbers. His experience as to the value
of electro-magnetism in deafness is not very encouraging.

The results of the investigations of Drs.Schmalze and Kra-
mer are of great importance in ascertaining the cause of deaf-
ness, by establishing system in this class of diseases, and fur-
nishing the student with a guide in further investigations;
and we confidently hope that some of our young physicians
wilj take up the subject, and as it is almost an unexplored
field in this country, that is, by our physicians, that they will
succeed in imparting more light on the causes of deafness
than has yet been made known, and not only the causes,
but the best methods of cure, that it may be no longer a re-
proach to the profession in our country, that auricular dis-
eases are not understood.

A new mode of treating certain cases of deafness has
lately been published in the London Lancet, as practised by

Moms on Deafness and Diseases of the Ear. 245

J. Yearsley, Esq., Surgeon to the Metropolitan Ear Institu-
tion. It is a method to treating the deafness caused by per-
foration of the membrana tympani. The former method
was to syringe out the mucus or pus from the cavity of the
tympanum, by passing air through the Eustachian tube,
which is often only a temporary relief, and frequently of no
service at all. His method is, with a pair of forceps made
for the purpose to place a small pellet of moistened cotton
wool at the bottom of the meatus against the portion of the
membrane still left, which seems to act as a vibrating me-
dium, care being taken to adjust the cotton upon the par-
ticular spot where the hearing is the most perfect. His suc-
cess has been great, and he gives a few cases as examples
of the treatment and its success. It is necessary that the
cotton be well moistened and changed when it becomes
dry.

T. Buchanan, Esq., Surgeon to the Hull Dispensary for
diseases of the ear, agrees with Mr. Yearsley in the success
of the experiment, and says, that the fibres of the cotton
stimulate the branches which lead to and from the tympa-
nic plexus, while it clings to the parietes of the tube, so as
to accommodate it to the usual strength of the undulations
of sound and insure the action of the ossicula by its elastici-
ty. He differs slightly from Mr. Yearsley vci the prepara-
tion and placing of the cotton ; he spreads it thinly over
the surface of the tympanum so as to cover the perforation
and remnants of the membrane.

A writer in one of the medical journals of our own coun-
try, during the last year, recommends dry cupping where
inertia exists in the excretory ducts of the meatus. He ap-
plies the cup on the head outside of the external ear and ex-
hausts the air till a sensation like extreme tension in the li-
ning membrane of the meatus is felt. This rouses the excre-
tory vessels into activity and they furnish the necessary flu-
ids for the successful action of the outer ear, which is as far
as the remedy is intended to apply.

W. R. Wilde, Esq., Surgeon to St. Mark's Hospital, Dub-

246 Morris on Deafness and Diseases of the Ear.

lin, has an article in an English medical journal lately, on
Sub-acute inflammation of the tympanum, in which he says,
the disease is only to be learned by a careful inspection of
the membrane, which presents a pink color, and in some
cases, a few long tortuous vessels, in the early stage of dis-
ease ; at the same time the ceruminous secretion is arrest-
ed, but no general constitutional symptom.

In the treatment of it he uses, with most beneficial effect,
the soft brown citrine ointment applied in a melted state
with a soft brush to the auditory passage, and the tincture
of the flowers and leaves of the Arnica montana — these in
connection with Mercury and Iodine have proved success-
ful in his hands.

These remarks comprise some of the most important por-
tions of the investigations and remarks that have been pub-
lished on this subject, and will serve as hints to induce
our young physicians to investigate the causes of deafness,
and devise methods of cure, and thus alleviate the distresses
and anxieties of many of our fellow beings. We hope, how-
ever, that no injurious impressions upon the minds of any
medical mind, either in this country, or abroad, may arise
from not noticing their exertions in this cause, as we should
be very happy to give credit where it is due. Our apology
must be a want of information as to the names of those who
have devoted their talents to it. We, therefore, omit the
names of many who have written upon deafness, believing
that they will appreciate the design of this article to be, to
furnish hints to the profession in a spirit of kindness.

NOTE.

Since the foregoing article was in type, the 47th number of the American
Journal of Medical Sciences has been put into our hands. It contains a val-
uable article by E. H. Clarke, M. D., of Boston. Mass., on Aural Surgery,
which gives an analysis of one hundred and forty cases of deafness, classified
according to Kramer; the results in the three first classes corresponding to
those enumerated by him, and approximating in the other. We recommend
a perusal of the article to our medical friends, and hope that Dr. Clarke will
persevere in his investigations, and give the treatment and results to the
public.

A Case of Monster, 247

Art. III. — A Case of Monster.

Very recently the periodicals of the profession have con-
tained reports of cases, presumed to establish the fact of
the foetus being influenced by maternal mental emotions ;
but these have been for the most part closely criticised by
those who deny that foetal life and devolopment are in any
degree affected by the mother's mental condition. The ques-
tion then remains unsettled, and it is proper in order to its
final determination, to give publicity to every case which can
be authenticated, and which bears on the point under dis-
pute.

During the year 1850, J. F. Hendrix, of Clinton, Ander-
son county, Tennessee, communicated to the editor of the
Knoxville Register, a case of tedious labor that terminated
in the birth of an unsightly monstrous being, a description
of which will seem incredible.

"The chest and abdomen seemed to be naturally formed,
but the spine was greatly convex — unnaturally curved.
The head was destitute of bone, except a partial formation
of the os frontis, and was disproportionally large, and much
elongated. The eyes were well devoloped and properly
placed. From below the eyes there w r as a projection, at
the extremity of which were the mouth and nasal orifices
— giving the nose a very obtuse appearance. The ears
were covered with a thick shaggy hair, of an acute shape,
and situated high on the posterior portion of the head, stand-
ing upright, and extending considerably above the vertex,
presenting really a frightful appearance. The arms taper-
ed from the body to their extremities ; the fingers were flex-
ed and webbed, forming a thick club-like hand, having two
round, hooked nails on each hand. The legs were rather
small, and the feet, comparatively long and slender, were
reversed, the toes being behind and the heels in front, — oth-
erwise similarly constructed to the appendages to the arms.

"The creature evidently belonged to the male sex, the pro-
creative organs being complete, and not differing materially
in conformation to the same organs in the bear.

248 Sutton on the Duties of Physicians.

"The only cause that could be assigned for this exceeding
strange phenomenon is the following. Shortly after con-
ception, a pet bear suddenly came into a room of the house
in which the woman was in some manner engaged, and oc-
casioned her much, and for the time being, terrible alarm.
Gestation progressed until the expulsion of the horrid being,
which has been thus described. The whole statement can
be corroborated by several responsible witnesses. The mo-
ther was a negro."

The communication does not state whether the gestation
was attended by any peculiar circumstances, whether
the labor was completed at full term or before, or
whether "the thing" that was expelled had life or not — all
of which are points of interest if not of importance. And
critics will ask, was the circumstance of fright from a bear
spoken of before the completion of the labor, and the dis-
covery of the unnatural formation of the generated being.

Art. IV. — Reflections upon some of the duties which physi-
cians owe to the community and to the profession, by W. L.
Sutton, M. D., Georgetown, Ky.

Modesty teaches us not to obtrude ourselves heedlessly
and without due consideration upon the notice of our fellow-
men ; whilst patriotism requires us to do all, w r hich in us lies
to advance the interest of our country ; and a proper pro-
fessional pride urges us to lend a helping hand to advance
the usefulness and honor of our profession. These motives
of human action are by no means incompatible, yet, it is
certainly not always very easy to know when we are actu-
ated by a laudable desire to do good, and when w T e are mov-
ed by an itching for notoriety. It is equally difficu It some-
times to say whether we are restrained from acting by a be-
coming modesty, or by indifference or want of industry.

These reflections have risen in my mind upon considering
the immense field open to the observation and experience of

Sutton on the Duties of Physicians. 249

physicians in the south and west, where cases requiring
medical and surgical treatment are so varied, and so numer-
ous ; and where, from the very nature of things, the practi-
tioner is frequently compelled to rely upon his own judgment^
and to treat the most formidable accidents or disease with-
out the aid or countenance of any brother, whose counsel he
would so gladly seek.

In these wilds, whilst the whoop of the Indian and the
howl of the wolf were still ringing in the ears of the early
settler, a Mc Dowel, a Branshaw and a Deaderick perform-
ed surgical operations, the accounts of which were received
by the surgeons of the Old World with a scowl of contempt
and declared not only unworthy of credit, but impossible.
How many analogous exploits sleep in obscurit}', or how
many equally noble triumphs of skill, achieved in the quiet
and unobtrusive treatment of diseases, no man knows.

As in our mountains and valleys vast mines of inexhausti-
ble wealth lie concealed, so scattered through our extensive
country there is, or ought to be, an amount of professional
treasure, which, if brought to light, would astonish the wis-
est heads in our land. To inquire why these mines are suf-
fered to be unknown and un worked, and to urge those who
are able to develope portions of these treasures, to bring
them forth, is the object of this paper.

The time has been when there was a serious difficulty in
the physicians, of this region, communicating the result of
their experience to the periodical press. Most physicians
indeed, scarcely knew that such a medium of communica-
tion existed— as in fact very lew did exist, and those few in
the eastern cities. The intercourse between this region
and those cities was slow, laborious and expensive. On this
side of the mountains, as well as on the other, there was a
general opinion that every thing on this side was consider-
ably inferior to what was on the eastern side. The prac-
tice of medicine was more laborious, and the habits of our
people were little favorable to composition. But great
changes have taken place within a few years. We have

250 Sutton on the Duties of Physicians.

medical periodicals scattered all over the length and breadth
of the land. Whereas it then took about three weeks to
make a journey to New York or Philadelphia, now it can be
accomplished in two or three days. Since intercourse has
become more free, we have learned that we are not so far
behind our eastern brethren as we had supposed. Owing
to the great increase of physicians the labor of each is very
much diminished.

It is true that, along with these changes, communications
from physicians have also increased. But have they in-
creased in proportion to the number, the leisure, or the abili-
ty of the profession? I presume not. Surely no one will de.
ny that the man, who makes an improvement in the treat-
ment of diseases is a public benefactor. If "the man who
teaches us to cause two blades of grass to grow where one
grew before, deserves the thanks of his country," what shall
we say of him, who by skill in developing the healing art,
increases the duration of life, the health and the happiness
of his fellow-men? From these considerations it follows,
that it is alike required by patriotism, professional pride, and
even individual reputation, that any thing which shall tend
to ameliorate the condition of man, should not be hid under
a bushel but set on a candle-stick.

What obstacles stand in the way of performing these im-
portant duties? One of the most common excuses for ne-
glecting this duty is "the want of time," "pressing profes-
sional duties." It is certainly true that the physician is pe-
culiarly liable to interruption. He may sit down to write an
article for the press, and perhaps before he has finished the
first sentence, he is required to attend to some case which
admits of no delay. This may be repeated time and again,
until he becomes entirely weaned from the undertaking.
Another excuse is, that periodicals are filled with articles
written by visionary men, without experience, and of course
of little value. Although there is some truth in this, yet an
intimate acquaintance with our journals would show that
the objection is by no means valid. Another excuse is, that

Sutton on the Duties of Physicians. 251

the notes of cases are so scattered, that it is difficult to col-
lect and arrange them for publication. Let us look into
these excuses and see to what they amount, and first, as
to want of time. It has been admitted that physicians are
peculiarly liable to be interrupted, yet there is much time
in the life of every physician which might readily be ap-
propriated to giving his experience to the public. Some
physicians of most laborious practice, yet find time to write
a great deal. I may instance Prof. Meigs, of Philadelphia.
The real objection is not want of time, but want of inclina-
tion or determination, and of method in arranging time.
There is an old proverb, "Where there is a will, there is a
way," in which there is much truth. If a physician wish-
es to see a friend married, or hear a famous orator speak at
a given time, he can almost always arrange his time so as
to do it. A certain medical friend usually carries writing
materials with him; when he is detained for an hour, yet so
that his patient does not require constant attention, he de-
votes the time to writing. It is told of a certain author, that
he wrote quite a little volume in the small portions of time,
which were necessary for his wife to put on her bonnet and
shawl, preparatory to taking a walk. Our estates are made
of dollars and cents, and our lives of hours and .minutes.
We have no more right to spend an hour of one without
benefit to ourselves or our neighbors, than a dollar of the
other. A physician has no more right to let valuable facts
lie forgotten or unknown, because he has not always the
leisure to arrange and publish them, than a farmer has to
let his produce rot in the field, because at some particular
times, two portions of his business press urgently upon him
at once. If he cannot attend to the matter to day, perhaps
he will be able to do it to-morow. At any rate, all that is
required, is, that when the opportunity shall offer, it be seiz-
ed and appropriated.

As to the states of Tennessee and Kentucky being so
sickly as to require the constant employment of the three
thousand physicians, who are within their borders, the idea
is too preposterous and absurd to need a comment.

252 Sutton on the Duties of Physicians.

But visionary and inexperienced men contribute most of
the articles published in the medical journals. If this was
true to the full extent of what is implied in the charge, what
then? There is no doubt but that it is a matter of pride as
well as of duty with the editors, to make their journals as
valuable and instructive as possible. If they publish essays
of inferior quality, doubtless it is because no better are at
hand. The journals must be published at the appointed
time, and if the erudite and experienced will not step forth,
they have no right to complain of the want of value in the
articles published. So far is this from being an objection,
it is, in my opinion, one of the very strongest reasons why
persons of experience, and those who think they have ob-
servations worthy of attention, should give to the profession
the benefit of their wisdom. If we should have journ als at
all — and surely no one will say that they can or ought to be
dispensed with — then certainly we ought to have the best
articles which we can procure. I have no experience in
editing, but I question whether our editors have much choice
in original articles — whether in fact, as many articles of that
class are offered as they would like to publish.

Again: The notes taken of cases have been so irregu-
larly recorded, that it would be a great labor to collect and
arrange them for publication. This is a serious difficulty.
It proves a want of due method in making records of cases,
yet by the aid of some industry, they could be brought to
light and made available. As a means of remedying the
evil, a committee for that purpose appointed, reported to the
late, meeting of the Kentucky Medical Society, the form for
a "case-book," which is peculiarly adapted to the purpose,
and which it is hoped, will soon get into general use. In
this book, great faculties for recording cases are given, and
whilst each case is kept separate, when the book is opened,
a glance shows the names of the patients and the character
of the cases there reported.

Backing the considerations of patriotism, professional
pride and personal reputation, the National Association, and

Ramsey on a Case of Tumor, 253

the state Medical Societies, through their various commit-
tees, are making direct personal appeals for facts and infor-
mation upon almost every point connected with the profes-
sion. A new impetus is given to the profession, and we
are individually called on to contribute our mites to make
the profession a still greater blessing to the community than
it has ever been. Who is so cold, so dead, as not to feel an
interest in this great movement? Who is so busy, but that
he can find some time to arrange and furnish some of the
important facts which his busy and eventful life has put in
his possession? It is confidently believed that the states of
Kentucky and Tennessee contain their full share of profes-
sional talents, why should those talents be buried and lost
to the world?

May we not hope that a new era has commenced, and that
carefully observed facts and important suggestions will be
reported to the various committees, and to the journals, in
such numbers as to wipe away all reproach as to supine-
ness, indifference, or negligence?

Art. V. — Case of Tumor, Operation — Anesthesia Death.
Communicated by Dr. Frank A. Ramsey.

On the 12th of November, 1851, Mr. John Trundle, set.
38, a worthy citizen of Sevier county, in this state, in com-
pany with his brother-in law, an intelligent physician, pre-
sented himself at my office for examination. Two other
practitioners of this county were solicited to give an opin-
ion in the case.

About nine years before the time of the examination, and
nine months after having received a moderately severe blow
in the left, the affected, groin, from the end of a stick of wood
which he was manufacturing into a plow-handle, he dis-
covered a small body about the size of a pea, situated be-
low the flexure of the groin and over the scrotum. After

254 Ramsey on a Case of Tumor,

fifteen months it had attained double the size it had, when
it first at tracted attention.

After eight years it had grown, and presented the shape
and extent of a goose egg, divided lengthwise, when it be-
gan to diminish, without any ascribable cause, until it be-
came one-eighth smaller; and a few months afterwards,
whilst under treatment for an inflammatory attack, he was
salivated, when coincidently, the tumor decreased rapidly,
until it was not larger probably than a longitudinal section-
al half of a partridge egg. In this condition it remained
until the fall of 1850.

At no period during this term of years was pain or sore-
ness of the tumor experienced, nor did discoloration of the
integumentary covering occur, nor were irregularities of
the surface of the tumor discoverable.

During the time of the changes in the size of the tu mor,
from its commencement until the spring of 1850, the pa-
tient says, "it was attached though shakeable." His phy-
sician thinks, and is sure, it was not attached. The patient
also says, "there was a cord extending from the tumor, and
running around and under the thigh, to the knee joint." But
his physician has been unable to distinguish any alteration
in the tissues which at all conveys to his mind the idea of
cord- like.

Without any cause known to the patient, the tumor com-
menced increasing. During the month of August, 1850,
whilst at labor in his field, his plough came in sudden and
forcible contact with a root, causing the handles of the
plow" to strike him near to, but rather above, the then loca-
tion of the tumor, and since its growth has been rapid.

It is to be remarked that neither the first nor the second
blow produced any bruise, or even the slightest discolora-
tion, occasioned but little pain at the moment, and none was
experienced afterwards.

The skin covering the tumor was free from discoloration,
until two months past, when it commenced assuming a light,
livid hue, which it now presents — except a certain portion,
which is shiny and scaly, presumed to have been caused by

Ramsey on a Case of Tumor. 255

Iodine ointment, which had been applied to the particular
part of the surface.

The tumor, until recently, has been uniformly hard, and
is now, to a very great extent, though at different points,
soft and elestic to pressure. It has never been painful, nor
has pain been developed by handling. At present, it is a
very little tender, at a point about the same as that on which
the last blow from the plow handle was received. The
sensations now experienced are described by the patient as
"twitching, or burning, not soreness or pain." And on bemg
asked if it was a sensation of distention, he answered, "that,
probably, is the best expression." At times the surface
itches excessively.

The surface of the tumor has been uniform, both to sight
and touch, until a few days ago, when a pimple appeared,
which was opened with the point of a lancet. From the
opening thus made a thin yellowish fluid has since been
constantly and freely discharged. About eight weeks ago
the scrotum, which, before was unaffected, became swollen,
and the whole surface of the tumor, became more soft.
Since the discharge has been established the scrotum has
assumed almost a natural state, and the tumor is very per-
ceptibly lobulated, two divisions or distinct lines of demarc-
ation being discovered, constituting three lobes, or seeming-
ly three tumors, with points of union.

At the time the opening was made the discharge was a
little bloody ; but there has been no appearance of blood
since, until to-day, the cloth is very slightly tinged red, and
a pale red drop or more has been seen.

The patient's general health in every particular good. He
is restless at night, and the muscles cramp, particularly af-
ter carriage exercise — his mode of riding.

The left leg is much more easily alfected by cold than the
other. It is also much larger throughout its whole extent,
down to the ancle, and slightly pits on pressure. The glands
of the groin are unaffected.

The tumor measures :

250 Ramsey on a Case of Tumor.

From Pouparts Ligament to base, directly down the thigh,
8 1-2 inches ; from Pubis, diagonally to its base, near the
middle of the thigh, 9 inches ; from Spine of Ilium, diagon-
ally to its base at the inner side, and near the middle of the
thigh, 10 inches ; from Trochanter directly across to a point
near the scrotum, 9 1-2 inches. The affected thigh meas-
ures: Just below the tumor, 22 inches ; just above the knee,
6 inches. The opposite, or unaffected leg measures at cor-
responding points, 18 inches, and three inches.

His attending physician had not been of the opinion that
the tumor is malignant, but had constantly recommended
excision ; and the patient uow desires the opinion of other
medical men, as to the nature of the tumor, and the neces-
sity, or feasibility of its being opened, or extirpated.

The great importance which attends the examination of
a large tumor is universally appreciated, as is the fact that
correctness in diagnosis is hardly attainable, and, therefore, it
is by no means surprising that in this case different opinions
were entertained and enunciated. One regarded it as a Fun-
gous Haematodes, and considered any interference,whatever,
out of the question. Another held the same opinion, as to
the nature of the tumor, but thought extirpation admissable,
as offering a chance for a prolonged continuance of life. An-
other did not regard the tumor as malignant, and advised
immediate exterpation, before the economy became involv-
ed in the irritative action proceeding from the tumor as a
focus.

With the views of the several practitioners in his posses-
sion,* the patient left for home ; and we heard nothing from
him, until 3 A. M-, December 1, when the following note,
by a messenger, was received from his attending physician.

Sevier County, November 30.

Dr. F. A. Ramsey — Dear Sir : Mr. Trundle has come to
the conclusion to have his tumor excised, and wishes you
and Dr. Rodgers to come and do it. It has enlarged some
since you saw it, and has been paining him for several days
very badly. He thinks it is nothing but death in the worst

Ramsey on a Case of Tumo?\ 257

event, and is conscious that he can not live many days un-
der present circumstances. You will gratify him very
much by coming to-morrow. Respt.,

R. Birdwell.
Come prepared to operate.

At 4 P. M., Monday, December 1, we reached the resi-
dence of Mr. John Cannon, the father-in-law of Mr. Trun-
dle, and found him very much changed since the examina-
tion of the 12th of November. After returning home from
Knoxville, he exercised himself considerably, in making ar-
rangements to visit some one of the northern cities for the
purpose of having his case investigated by some expert in
surgery. His general health seemed to remain unaffected
until Friday last, November 28, after some hours of increas-
ing malaise he had three chills, and very rapidly declined
in strength. At the time of our visit his pulse beat 128 to
the minute, countenance anxious, brows knit, appetite poor,
bowels regular, and he was almost constantly moaning.
He complained of "acutely burning" and "hot burning pain,"
and on being asked as to its location, affirmed that it was
"confined to the surface." Large and frequent doses of
Opium had mitigated, occasionally, his sufferings, without
at all disturbing his head. And he says, "shaking the tumor
will as certainly quiet the pain, as rocking the cradle will
still a baby."

The tumor's extent is something greater than the admeas-
urements which have been given. And an idea of its size
and location may possibly be gained from the following:
Commencing with the Spine of the Ilium it extends to the
Pubes, and thence down the thigh, to about the angle made
by the Sartorius, crossing the Adductor Longus, and the
Rectus Internus, thence across to the tendon of the Fascia
Lata muscle, and thence back to the Spine of the Ilium.
The descriptive boundary is not strictly correct, the line of
the base of the tumor being irregular.

The tumor presents three apexes, defined with more or
less distinctness ; the skin covering the whole tumor is

258 Ramsey on a Case of Tumor.

very greatly on the stretch, and ulcerated in four places — one
ulcer oblong, the others round — and rapidly extending and
running into each other. The edges of the ulcers are regu-
larly defined, and wholly distinct from the membrane of the
tumor, which presents a greyish color. A probe passed be-
tween the membrane of the tumor and the skin, from one
ulcer to another, but at points the attachment between the
skin and tumor would not permit the play of an intermedi-
ate substance, as a probe or a thin spatula. From the ul-
cers is constantly oozing a thin serous discharge deeply im-
bued with Haematen, and abundantly albuminous. Occa-
sionally when the sac is pressed, blood will run for a moment.
An exploring needle plunged for two inches through the sac
into the body of the tumor, returning loaded with black ve-
nous blood. From one, and perhaps, two of the ulcers, a
cream-like, straw-colored matter was pressed, and presum-
ed to be pus.

The skin below the ulcers was a deep red, somewhat
glistening color — certainly Erythmatic, if it was not Ery-
sipelatous, as it was pronounced by some of the practition-
ers present. At these points an animal thermometer stood
at 71 deg., at other points not so high. Temperature of pa-
tient under axilla 64 deg., temperature of room 60 deg.

At particular spots of the tumor there is an elastic hard-
ness, but for the most part it is much softer than when last
examined. The Epididymus of the left testicle seemed to
be enlarged, and one or two hardened glands were discov-
ered.

Dps. James Rodgers, Birdwell, Dickson, McNutt and my-
self, after fully considering all the attending circumstances,
though differing somewhat as to the intrinsic nature of the
tumor, were satisfied that life would be speedily extinguish-
ed, if existing circumstances continued to prevail. And
such was the extreme prostration that we doubted the ca-
pacity of the system to sustain the shock of an operation.
Yet, as an operation offered the only possible chance for
life, we determined on its performance, in the event the pa-

Ramsey on a Case of Tumor. 259

tient and his friends, after hearing our opinion, should so
elect.

After a very mature deliberation he announced his de-
termination, by the advice and hearty concurrence of his
friends, to have the tumor removed.

The time we were making preparation for the operation,
was employed in Bible-reading and prayer, by a minister of
his own denomination, with the assembled family and
friends, and seemed to occasion no excitement whatever ;
indeed, he afterwards shaved himself. When we first ar-
rived at the room of the patient, his pulse was noted 128,
and though frequently observed, it never varied one stroke,
even up to the moment that the anesthetic sponge was ap-
plied to his nose, nor did it alter, perceptibly, in its force or
volume — it was from the first observation remarkably
thready.

At 5 to 1, P. M., Tuesday, December 2, a handkerchief
impregnated with equal quantities of Chloroform and Le-
theon, under the control of Dr. Dickson, was applied. The
combination induced great excitement, and imparted a de-
gree of muscular vigor, which rendered the patient unman-
ageble, and after some minutes — ten or more — Chloroform,
uncombined, was used. Under the influence of this agent
he soon became quiet, and lay without stertor, occasionally
giving a groan or making a remark. Several times during
the progress of the operation, Dr. Dickson, thinking the
face too pale, the pulse sinking, and the respiration verg-
ing on unnatural slowness, and too deep, substituted Le-
theon for Chloroform,when the pulse rose, the respiration be-
came more natural, and the patient talked and moved — even
raising his body from the table.

The operation was conducted by Dr. Rodgers and myself.
Our object was to lift the sac from its bed, at its lowest
point over the ligament of the Fascia Lata muscle, and pro-
ceed thence to detatch the tumor from the regions of the
large blood-vessels of its internal upper location.

The first incision was made at 1, 15 P. M., beginning at

260 Ramsey on a Case of Tumor.

the lower ulcer, and extending to the lowest part of the tu-
mor. The skin at the point of commencement was very
thin, and there seemed to be no intervening cellular tissue,
which further progress in the operation exhibited in great
abundance, and exceedingly condensed at other parts. The
incision penetrated the sac of the tumor, and a considera-
ble quantity of very black blood was discharged, which co-
agulated rapidly on the table, and causing a delay of seve-
ral minutes in the continuousness of operative action.
Then, several times this occurred, until apparently the
sac was empty of blood, though it collapsed to a very
slight extent. The quantity of coagula thus formed was
probably not more than three pints ; and the blood thus lost
was wholly from the tumor, and was evidently contained in
distinct appartments, flowing only when particular portions
of the sac were penetrated. The great difficulty of the
operation consisted in cutting through the hard condensed
cellular tissue which almost surrounded the tumor on its
surface next the skin, and which, of course, we wished to
remove with the tumor. From the prevalence of this con-
densed tissue, and the irregularity of the tumor, we found it
necessary to make four incisions through the integuments,
at different times, running from the centre of the tumor to
the four corner points. The tumor lay wholly above the
muscles, except at one point a prolongation extended down
by the side of the Adductor Longus. This was raised by
insinuating the fingers under, and lifting it from its bed;
and just as this was accomplished, the sac broke and dis-
charged a thick cream-like matter. Behind or below this
prolongation the tumor was penetrated by a large vein,
which was necessarily cut, and from which, probably, three
ounces of blood were lost. A short distance from this point
and above, a very small muscular artery was opened, when
separating the tumor from its attachments, with the handle
of the scalpel. This was stopped from bleeding by torsion,
pressure with the finger being sustained for several mo-
ments after. The appearance ot the muscles was very

Ramsey on a Case of Tumor. 261

dark, and at no point could the large blood vessels of the re-
gion be discovered, though during the operation the pulsa-
tion of the femoral artery was diligently and anxiously
sought after. It was suggested that the vessels were all
obliterated by the pressure ot the tumor.

The patient was passed from the influence of the Chloro-
form before the tumor was wholly detached — a few mo-
ments having been lost waiting for some slight unpleasant
manifestations to yield to restoratives. The wound was
washed, and dressed with adhesive strips, and compresses
of fine lint, and put to bed at 3, P. M. No hemorrhage
occurred ; a very abundant serous discharge soiled the
dressing.

From 3 to 6, P. M., stimulants were very freely adminis-
tered. About this time the pulse commenced increasing in
fullness, the surface became full, warm enough, and nausea
with vomiting occurred. Occasionally he complained of
pain, and all the time, of soreness in the wound. From 6
to 9, he continued very evidently improving — voice becom-
ing firm, pulse full, though too frequent, and more general
sensation of comfort. Abcut this time he wns asked how
he felt, and answered, comfortably but weak. At 10, he
sent word to his wife in another room, that he was better
and improving. At 12, while asleep, he was observed to
be breathing with difficulty, and his pulse to be scarcely
perceptible, and rapidly sinking. From 6 until 12, vomit-
ing occasionally occurred — he had frequently a sup of wa-
ter, which with the stimulants, constituted the matter thus
ejected. At half past 2, up to which time he was conscious
and rational, he turned himself upon his right side, and lay
comfortable, breathing slowly and without stertor — the in-
terval between successive respirations growing longer, un-
til 3 o'clock — just 12 hours from the time he was put to bed
after the operation, he died. His muscular strength in it-
self did not seem to be impaired to the last.

A description of the tumor is reserved, until it can be
submitted to microscopical examination, when its general
characters will be given in detail.

ECLECTIC AND SUMMARY.

MIDWIFERY.

June 14. — Fatal Hemorrhage from the Fanis. — Dr. Storer
reported the case. Dr. S. was called, May 23, at 10 P. M.,

to Mrs.T ,in labor with her fourth child. In an hour she

was delivered of a fine, large, healthy-looking child, weigh-
ing about eight pounds. The funis was tied with a piece of
narrow bobbin. After seeing the swathe applied and the
patient comfortable, Dr. S. left her. At about five the next
morning he was called to see the child, which was bleeding
from the funis; found it pallid, cold, the pulse scarcely per-
ceptible. Efforts were made to revive it, but it died in a
few minutes after Dr. S. reached the house. The ligature
applied just after birth was still upon the funis, and at the
extremity of the funis was a coagulum.

After the birth of the child, Dr. S. waited, as is his cus-
tom, for the pulsation of the cord to cease, and then applied
the ligature with the usual force, examining to see if the
bleeding was stopped ; and again, after the expiration of
fifteen or twenty minutes, after the mother had been swath-
ed, he looked, as he invariably does before leaving the cham-
ber, at the funis. It did not bleed. It appears, from the re-
marks of the nurse that the child was applied to the breast,
in about one hour after Dr. S. left. No bleeding was then
noticed, and the child readily took the nipple. Between
four and five in the morning, four or five hours after birth,
its clothes were found saturated with blood, and Dr. S. was
sent for. That the ligature was applied with as mnch care
as is*usually taken, Dr. S. is certain. The fact of there be-
ing no bleeding at the end of nearlj 7 half an hour after the
funis had been tied shows this to have been the case. The
bleeding seemed to be produced by the gradual contraction
of the paiietes of the funis, by which the ligature became
loosened.

Does not the result of this case prove that it is well in all
cases to wait until the pulsation ceases in the funis, before
applying the ligature? This was done here and the case
was fatal. Would not this accident be more likely to oc-
cur if this caution were not observed ? Dr. Storer added,

Eclectic and Summary. 263

that he remembered hearing one of our oldest practitioners
relate a case to this Society, in which the ligature having
been applied, the funis was severed next the child, within the
ligature, no bad consequences ensuing. The absurdity of
such a practice ever being justifiable is strikingly shown by
the case above recorded.

The child was examined, post-mortem, by Dr. Jackson,who
found nothing abnormal.

Dr. Townsend, Jr., reported a case in which the bleeding,
which occurred a few hours after birth, and which was
quite profuse, ceased spontaneously.

Dr. Jackson supposed the bleeding, in the case narrated
by Dr. Storer, to have been from the unbilical vein, as this
vessel was found open while the arteries were shrunk.

Puerperal Convulsions ; Premature Labour. — Dr. Storer
reported the case. May 27, visited Mrs. H., at the request
of her physician. Saw her at 5 P. M. She was, at that
moment, struggling with an epileptic convulson, which last-
ed about three minutes. She had, since one o'clock in the
morning, twenty-eight similar attacks. Upon examining
the case, Dr. S. found she was twent}' years of age, and
this was her first pregnancy. She expected in a week or two
to have terminated her time. The attending physician had
bled her, and made cold applications to her head without re-
lief. She had slight pains, and upon examining the os uteri
it was found to be sufficiently open to reach, with an effort,
the unbroken bag of waters. Dr. S. advised puncturing the
membrane, which was readily accomplished. After the
waters had passed off, and the pressure was partially re-
moved, the convulsions were less severe ; and, for an hour
previous to her delivery, none occurred. At 8 o'clock, about
three hours after, her child was thrown off, still. She soon
became comatose and died.

Bleeding and the anaesthetics have so often failed of suc-
cess in puerperal convulsions, that Dr. S. was induced (re-
calling a case of this kind occurring in his own practice
two or three years since) to suggest the above course of
treatment, and he can not refrain from thinking that, had it
been adopted earlier, the result might have been different.

Abnormal Presentation of the Faztus. — Dr. Storer reported
the case. The presenting parts were the two hands, and
between them the right foot. The pakent lived out of
town ; had had five children ; at each accouchement she had
been attended by a midwife ; her labours had been natural.

264 Eclectic and Summary.

Dr. S. was called to see her at 10 o'clock P. M., on the 29th
of May. She had been in labour since the morning of the
day preceeding. Two midwives were in attendance ; one
had been with the patient since the commencement of the
labour, the other during the second day. On Dr. Storer's
arrival, he found the patient not much exhausted nor de-
pressed in spirits ; on examination Dr. S. discovered that
the mouth of the uterus would allow two fingers to pass
readily, and a third when the three were drawn together
with some effort. After some difficulty, Dr. S. made out
the presentation of the hands and one foot in conjunction;
he had never before met with such a case. The contrac-
tions of the uterus were strong, rendering the examination
difficult and tedious. A loop of the funis hung from the
vagina, having presented, according to the attendants, since
the passage of the waters, more than thirty-six hours pre-
viously. The child was dead ; how should it be delivered?
The head could not be reached by the forceps or crotchet ;
an arm might be drawn down, and the case left to sponta-
neous evolution ; or, when down, the arm might be amputa-
ted and the foetus eviscerated. Dr. J., however, preferred
to turn and deliver by the feet; accordingly, by the aid of
ether having effected some relaxation of the uterus, he com-
menced his operations. The right foot, compressed be-
tween the two hands, presented at the brim with the toes
towards the abdomen ot the mother. Finding it impossible
to bring down the presenting foot, from its being so firmly
wedged between the two other members, Dr. S., after a
long trial, succeeded in pushing aside a hand and then the
arm, which gave opportunity to search for the other foot ;
this being found, after long-continued effort, high up in the
pelvis, on the left side of the uterus, was brought down ; and
while in process of descending, the child rotated and both
feet presented at the vulva, with the toes towards the pubis
of the mother. After the birth of the body, the head was
readily disengaged by raising the abdomen of the child up-
wards towards that of the mother, causing the occiput to
travel over the sacrum. While endeavoring to bring down
the second leg, the presenting foot was kept in place by a
fillet over the ankle. The whole operation occupied a lit-
tle more than an hour ; in half an hour after removing the
child, the patient was left comfortable.

In relation to this case, Dr. S. remarked that, had the
child been living, it would have been proper to have brought

Eclectic and Summary. 265

down, if practicable, but one foot ; the superior bulk of the
breech and thigh acting much better than a single limb in
affecting dilatation of the parts, and in thus facilitating the
progress of the head. Dr. S., while mentioning never hav-
ing seen such a case, stated that none similar to it had been
noted by Dr. Lee, in* over one hundred cases of preternatu-
ral labour ; although a case is mentioned by Madame Boi-
vin. in which all the four extremities presented ; and he in-
timated that such a presentation might possibly have been
produced by some other power than that of nature.

Dr. Storer also related the following case of Placenta
Prcevia ; Death from Exhaustion. — On the 26th of May, at
6 P. M., he was called to see the patient in consultation.
The attending physician had been summoned several hours
previously on account of a sudden hemorrhage, while the
patient was sitting upon a cabinet. Cold was applied, and
the vagina was plugged ; blood still flowed in small quanti-
ty, till the patient became enfeebled, and it was estimated
that about one gallon of blood had been lost. Dr. S. was
now called, and advised, as the placenta was found to cover
the os uteri, its immediate detachment. This was effected,
and the hemorrhage ceased. Dr. S. advised, additionally,
that the patient be watched, and that no attempt be made
to deliver ; he was called again at 4 o'clock the next morn-
ing : the head had now descended into the pelvis, but the
expulsive efforts were feeble, and the child was delivered
by the forceps. The patient remained comfortable for two
or three days, when she began to sink, and died on the eighth
day after delivery. Dr. S. was of opinion that, as nothing
could have been done in the outset to hasten delivery, from
the unrelaxed state of the os uteri, death was probably, de-
layed by the non-interference.

Hemorrhage from tlie Funis on the Second and Third
days after Birth. — Dr. Snow related the case. He was
sent for on the second day after birth, some hemorrhage hav-
ing occurred, and he then applied a new ligature, supposing
the bleeding to be from the cut end of the cord. He was
again summoned the following night, the hemorrhage still
continuing; a third ligature was applied. On the next day,
the child appeared to be dying; and, on removing all the
cloths, the blood was found to proceed from around the base
of the cord. The nurse had removed the dressing from the
funis on the day after birth, which Dr. S. thought might
have caused the accident.

266 Eclectic and Summary,

In reply to a question by Dr. Minot, Dr. Snow remarked
that there was no yellowness of complexion, nor any thing
peculiar in the external appearance of the child, which
died on the fourth day.

Microscopic Anatomy of the Foetus. — Dr. Durkee exhibi-
ted some beautifully prepared specimens from the foetal
subject, arranged by himself with great care and skill for
the microscope, and showing the villi and mucous follicles
of the stomach and small intestines ; the appendix vermi-
formis ; mucous surface of the trachea and oesophagus ;
sections of the kidney, showing the stellate distribution of
the blood-vessels upon the suiface, and the veins distributed
in sets on the tubular portion ; sections of the thyroid, thy-
mus, and mesenteric glands ; the pancreas and lungs ; also
a portion of the choroid coat having the venae vorticossae
and pigment-cells injected, and being distinctly shown both
by transmitted and reflected light. Dr. D. likewise showed
some specimens of the skin from an adult subject, wherein
the loop-like arrangement of the capillaries which are sent
to the papillae was very manifest ; this is to be seen to good
advantage in the palm of the hand and under the nails.

Dr. Jackson stated that the foetus from which the above
specimens were obtained was taken from a woman aged
forty-two years, after her death, and who was supposed to
have died of an abdominal tumor. The real cause of her
death was not, however, disclosed by a post-mortem exami-
nation. She had been in labour two days, unknown to the
family, when she was attacked by convulsions at 10 o'clock
in the evening, and died next day at 5 o'clock A. M. The
probable cause of death was effusion into the brain.

Dr. J. showed the ossicula of the foetal ear, consisting of
three bones, the incus ani orbiculare being united and form-
ing one, as is usually the case, except in the foetus, where, it
is said, these two bones are detached. Dr. J., however, had
seen-one case previously, where, in the foetal state, these
bones were united.

June 28. — Ventral Hysterocele. — Dr. Storer reported the
case. June 2. Three weeks since, Dr. S. visited Mrs. W.,
Pleasant street, who expected to be confined in a few weeks.
Upon inquiry being made, it was ascertained that the pres-
ent is her third pregnancy. The first labour was tedious,
and her child was stillborn. In her second pregnacy, she
was delivered at the eighth month, and her child had been
dead sufficiently long to have become offensive to the by-

Eclectic and Summary. 267

standers. Since her last delivery, which occurred about a
year since, her health had been poor. She is now quite
languid, palid, evidently much depressed ; thinks she can
never have a living child.

Upon examining her abdomen, Dr. S. noticed a very sin-
gular condition of the recti muscles, which were separated
so extensively from each other that there existed a peculiar
sacculated appearance of the abdomen, which was strik-
ingly marked upon any forward motion being made by the
patient. This separation was observed along the whole
extent of the linea alba. The projection between the recti
muscles resembled that produced oftentimes by an enlarged
ovary ; and the feeling transmitted by examining the her-
nia was similar to that of an exaggerated fontanelle, and
beneath the finger the number of the several extremities of
the foetus could be defined as clearly as if a rupture of the
uterus existed.

The foetal heart was feebly pulsating. At the expiration
of a week, Dr. S. again saw the patient. She was exceed-
ingly depressed, and remarked that she had not felt the mo-
tion of the child since Dr. S. examined her. Upon a repe-
tition of the examination, no foetal pulsation could be heard
and it was concluded that the child must be dead. Dr.
Putnam, to whom Dr. S. had spoken of this, to him singu-
lar abdominal hernia, saw her a day or two afterwards.

Now, June 2, patient is in labor. During each uterine
contraction, the organ was thrust between the recti muscles
with great force ; and, fearing that serious results might fol-
low, Dr. S. applied a broad swathe around the abdomen.
The labor continued only about two hours, and the patient
did not suffer unusualty. The child was still, and exhibited
large patches upon its surface, where the cuticle was en-
tirely denuded. The condition of the placenta, which was
quite small, indurated throughout and exhibiting upon its
foetal surface two large cysts, each of the size of a chestnut,
filled with congula, readily accounted for the death.

Patient does not remember that any similar condition of
the abdomen existed in either of her former pregnancies ;
nor does she seem to have experienced any decided incon-
venience during this last pregnancy, except during any for-
ward motion. The mere stooping forward to wash the cups
after a meal produced so much uneasiness that she had
been obliged to desist from the operation for weeks previous
to her delivery. She can not recall any violent exertion by

268 Eclectic and Summary.

which the separation of the linea alba could have been in-
duced.

Dr. S. added that, from never having previously met with
a case of ventral hysterocele, and from the fact that those
writers who refer to the subject point to individual cases
which have been published, he inferred its rare occurrence.

Remedy for the Nausea and Vomiting of Pregnancy.— Dr.
Gould spoke of the application of chloroform to the epigas-
trium as having been found to afford prompt and permanent
relief in lour cases of the above affection. A few drops,
only, were applied at a time.

Dr. Bigelow was of opinion that chloroform acted as a
counter-irritant. He mentioned the case of a patient in
whom vesication was produced by a few applications of
this substance for pain in the side. It had not always been
found to relieve pain. Dr. B. had tried the chloroform oint-
ment, spoken of at a recent meeting, by Dr. Channing, in
various forms of Neuralgia, and, in a few cases, had ob-
tained temporary relief; in no instance was the relief per-
manent. Dr. B. doubted the alleged anodyne properties of
chloroform, when applied to the skin, as it can not act
through the cuticle.

Dr. Storer remarked that, although nausea and sickness
in pregnancy may be temporarily relieved by this applica-
tion, he was in doubt as to its affording permanent relief,
the affection being of a sympathetic nature. He consider-
ed the cases reported as possibly exceptional.

Dr. Coale related a case in which the sickness came on
when the patient rose from the horizontal posture. In this
instance, chloroform afforded immediate relief, lasting three
to four hours, when it became necessary to renew the ap-
plication.

[At the next subsequent meeting of the Society,

Dp. Alley reported a case of morning sickness in a patient
seven months advanced in pregnancy. Relief was obtain-
ed by the external application of chloroform to the epigas-
trum. The remedy was applied four or five times in the
day, for two successive days, with entire relief to the pa-
tient, producing little or no irritation upon the skin, a slight
redness only being perceptible.

In answer to Dr. Storer's inquiry whether the relief were
permanent, Dr. A. replied that four days had now elapsed
since the disappearance of the symptom. No other coun-
ter-irritant remedy was employed.

Eclectic and Summary. 2G9

Dr. Snow asked Dr. Storer if he "had employed, successful-
ly, any other counter-irritant remedies in this affection.

Dr. Storer had tried the usual remedies of that class, but
without expecting, or having found, permanent relief from
them. He had frequently seen temporary relief follow the
employment of blisters, &c.

July 12.— Almost complete Occlusion of the Vagina. — Re-
ported by Dr. Hayward, Sr. Dr. H. stated that he had re-
cently operated in a case of this nature. The patient had
always menstruated regularly, but with pain. She had no
suspicion of her condition until marriage, which took place
about a year since, when sexual connection was found im-
practicable. On examination, a septum was found at some
considerable distance from the external orifice, with an
opening in it so small as only to admit a small probe. A
director was afterwards introduced, and then an attempt was
made to carry in a bistoury, which was finally successful.
A catheter was now passed into the urethra, and the sep-
tum incised in all directions, except towards the bladder.
After this, Dr. H. was enabled to introduce the finger, and
to pass it completely around the os tincee. This is the fifth
case of occlusion of the vagina that has occurred in his own
practice. Two of these were cases of imperforate hymen.
The third was a case of congenital malformation of the
vagina successfully treated by an operation. Another was
one of occlusion produced by sloughing after instrumental
labour. This last was also relieved by an operation, the pa-
tient having since a living child. In the case above report-
ed, the septum was unusually firm, cutting like tendon. On
examination, six weeks after the operation, it was found
that it had afforded complete relief.

Unusual quantity of Liquor Amnii ; the Placenta and
Faitus healthy in Appearance. — Reported by Dr. Storer.
The patient was in her third pregnancy. When in her first,
she was enormously large, and was delivered of a dead
child in the sixth month ; the amniotic fluid being in great
abundance. In her second pregnancy, the abdomen was
also greatly distended, and the labour came on at the eighth
month ; the child dead as before. In the present case, la-
bour occurred at the eighth month ; there was great disten-
sion of the abdomen, and the child, as in the two former in-
stances, was still born. A peculiarity of this case was the
healthy appearance of the child and of the placenta, in each

270 Eclectic and Summary.

instance ; a condition not usual in cases where the liquor
amnii is in excess.

Early Menstruation. — Dr. Minot reported the case of a
woman, twenty-three years of age, who had recently con-
sulted him for headache, having been bled one year before
for the same trouble. This patient was run over by a wag-
on, when nine years old, since which she has menstruated
regularly, the function being always attended with much
pain.

Obstinate Diarrhoea preceding and following Labour. —
The case was related by Dr. Storer. The patient was first
seen by Dr. S. ten days ago. She had had Diarrhoea for a
fortnight, and expected to be confined in one month. On
the second day after his visit, she was taken with pains re-
sembling those of labour, and at the end of the second day
labour came on ; it being the eighth month of her pregnan-
cy. On the following day she had nine discharges from the
bowels. Lead, Opium, and Catechu were given without
effect. Finally, Sulphate of Copper, in the dose of one-
sixth of a grain, combined with ten or twelve drops of
Laudanum, was administered. Dr. S. feared a fatal result.
The patient has, however, been improving for two days
past, having had but three discharges during the last twen-
ty four hours.

26th. Reported his patient entirely recovered.

Puerperal Convulsions ; Death of Patient, undelivered.—
Dr. Storer was called in consultation with an other practi-
tioner, at 10, 15 P. M., July 19, to a patient in puerperal
convulsions. She was attacked at six in the morning, and
had repetitions of the attacks during the entire day, at long-
er or shorter intervals ; generally, about an half hour inter-
vening between them. She had been bled at 2 P. M., and
at 6 P. M., about twenty ounces each time, but still her
convulsions continued.

The patient, a woman about twenty years of age, at her
full period of pregnancy, had the aspect of approaching
dissolution. She was perfectly unconscious ; the surface of
her body was cold and damp ; the pulse exceedingly feeble.
While examining her, she had a terrific convulsion.

Upon examination, Dr. S. found the os uteri slightly open,
just allowing the index finger to pass, and to ascertain that
a head presented. He advised that premature labour be
attempted ; there appeared but little chance that it could

Eclectic and Summary. 271

be accomplished, but no other alternative presented. The
membranes were readily ruptured. Prevented by una-
voidable professional engagements from remaining with
the woman, Dr. S. requested the attending physician to
watch her through the night, and, should she die, as it ap-
peared most probable she would, undelivered, to open the
abomen immediately and remove the foetus.

Dr. S. was informed the next morning, by the gentleman
in attendance, that the convulsions continued to recur
about every twenty minutes, until a little past 12 o'clock,
when she died, a few minutes after the cessation of a par-
oxysm.

Dr. immediately opened the abdomen of his patient,

and removed a child, with its extremities so contracted and
rigid as to be straightened only by the application of con-
siderable force ; and with its surface livid throughout. Ex-
aming again, he removed a second foetus, less rigid than
the former.

Dr. S. stated that, in this case, as in that reported by him
on the evening of June 14th, he supposed the child would
probably be dead, inasmuch as the convulsions had existed
so long a period previous to an attempt being made to
produce delivery; but he requested that the abdomen of the
woman might be opened as soon as she ceased to breathe,
as the living foetus has been extracted after the death of the
convulsed mother.

Speaking of the treatment of puerperal convulsions, Co-
lombat observes (Amer. ed,, p. 649;): "Shouid the mother
have breathed her last during the progress of the labour,
the Caesarian operation ought to be performed, notwith-
standing the slight chance of success in such an attempt to
rescue the life of the child." — Amer. Jour. Med. Sciences.

New Mode of Resuscitation, by Dr. T. Wood.

July 30th, 1852. — Mrs. C was brought to bed in

her first confinement, and had a very protracted and tedious
labor, from a rigid, unyielding vulva. The child on deliv-
ery was in a state of syncopy, so profound as to leave but
little hope for a restoration to life. Full five minutes had
been lost in fruitless efforts to excite breathing, and the only
sign of life observed in the child was a slight convulsive ef-
fort while its lower limbs were yet in the vagina, after

272 Eclectic and Summary.

which it lay flacid, exsanguineous, and in appearance dead.
Cold air, cold water, and brandy had been thrown on its
chest without producing the slightest effect, and I was
about to inflate its lungs, when I noticed that the vessels of
the cord were much distended with blood, and a very fee-
ble pulsation in its arteries. Finding this condition of the
cord, suggested the idea that, perhaps, if the blood it con-
tained could be forced into the circulation of the child, it
might afford the required stimulation. Instantly acting on
the suggestion, I took the cord between my thumb and fin-
gers, and drew its whole length between them, so as to
force the blood into the child, when it immediately cried
lustily, and animation was completely restored. It had no
more difficulty in beginning life, and is now doing well.

I report this case under the impression that this mode of
treatment is original.

Since having the above case, I tried the same treatment
in a child that was delivered after a long labor, embarrassed
bv convulsions. Animation was at once restored on forcing:
the blood from the cord into the circulation of the child,
but there was not, previous to resorting to this means, such
complete prostration of the child as in the first case, and
though effectual, the result was not so striking.

My friend Dr. A. M. Slocum informs me that since I re-
lated my case to him, he has tried it in a similar prostration
of the child, with the same happy result.

Obstetrical Auscultation; Signs of Pregnancy, by M. M.
Rodgers, M- D., Rochester, N. Y.

It is not designed, in this brief article, to describe in detail,
all the signs of pregnancy, or to consider them in the order
of their relative value. We shall only notice briefly those
signs which usually accompany utero-gestation, and which
in the aggregate furnish strong presumptive evidence of
this condition. As these signs, however, are all more or
less equivocal, whether taken individually or collectively,
we propose to consider the value of those results furnished
by auscultation. If, by this mode, we are able to arrive at
a sign, which, taken alone, and independently of all others,
will at all times give unequi vocal positive evidence, — its im-
portance in a medico, legal, moral, and scientific point of
view will be admitted by all. The signs upon which we

Eclectic and Summary. 273

have formerly been accustomed to rely for a diagnosis in
suspected pregnancy, may be noticed, for the purpose of
showing, not what they indicate, but what they do not in-
dicate, for their evidence is entirely negative.

1. The general condition of a woman enceinte, may lead
to this suspicion, especially if she be primiparous. 2. The
cessation of the menses, but there are so many exceptions to
this, that it can not be relied upon : menstruation may con-
tinue in cases of pregnancy, until nearly the close of the
term, and may cease in women not pregnant. 3. The
morning sickness, which occurs usually, between the sixth
and twelfth week, is often absent. 4. Salivation occurs in
some cases, but may arise from other causes, and is not often
present. 5. Enlargement of the Mamma}, is a pretty con-
stant sign, but is occasionally absent, and may occur under
other circumstances also. 6. The areola and enlargement
of the follicles, are also nearly constant, but occur under
other circumstances. 7. Secretion of milk usually takes
place during the latter half of the term, but not always:
it may occur also, in women not pregnant, and even in girls
and men. 8. Increased size of the abdomen, when taken in
connection with other signs, is of value, but it may be a
consequence of disease also. 10. Dullness on percussion,
over the abdomen must occur in pregnancy, but may be
found in other conditions. 11. Quickening, or the motion
of the foetus, usually occurs at the end of the fourth month,
and is a very constant sign, but it may sometimes be pro-
duced by the voluntary or involuntary action of the abdomi-
nal muscles, and is sometimes never felt, in cases of real
pregnancy. 12. Ballottement, next to auscultation, furnishes
the most unequivocal evidence, and is considered by some au-
thors, infallible. But, on the authority of Prof. Depaul, of Par-
is, it has led to the error of pronouncing a hydatid tumor a
case of pregnancy. In the case of twins, and where there
is a small quantity of amniotic fluid, it is sometimes impos-
sible to obtain the result. 13. Violet color of the vagina, is
very generally present in pregnancy ; but the writer has
seen this test made extensively in Paris, when it occasional-
ly failed both ways. 14. Changes in the uterus, may occur
similar to those of pregnancy, from disease. 15. Buffy coat
on the blood, is considered by some authors a sign worthy of
confidence, but this occurs in so many diseases of both sexes
that it must be of little value as a test. 16. The urine is
said to contain an unusual quantity of uric acid m pregnan-

Eclectic and Summary. 274

cy, but this occurs also in diseases of both sexes. 17. Kies-
teine is usually present in the urine of pregnant women, but
is also found in the urine of men and children, as a result of
peculiar diet and disease. 18. Palpation of the abdomen
sometimes affords very strong evidence of the presence of
a foetus, but is seldom reliable alone. 19. Besides these,
there are several minor signs which are of some value, con-
sidered with the others : such are, variations of the pulse,
the appetite, maculae on the face,vaginal secretions, venereal
desires, organic sympathies, mental conditions, temper, age,
presence of the hymen, certain diseases, &c.

Now we see that these signs, taken together or singly, yield
equivocal evidence, — evidence which at best is only nega-
tive. We want a sign which will, in all cases where it is
present, give positive proof; and the sign is furnished by
auscultation.

The bruit placentaire, is an intermittent, whizzing sound,
resembling the bruit de soufflet of the heart, and sychronous
with the maternal pulse. It may usually be heard from the
end of the second month of utero-gestation, until the last
pains of labor. This sound is sometimes simulated by the
ovarian vessels, the uterine sinuses, abdominal vessels, the
vessels of fibrous tumors and aneuresmal varix ; but it need
not be confounded with any but the latter sound. This
sound is now supposed to be in the uterus, and not, as for-
merly, in the placenta; it does not, when present, indicate
pregnancy positively, — nor when a foetus is present, does it
indicate its life, as it may continue for sometime after death
takes place. The funis soufflet, may sometimes be heard
intermitting sychronously with the foetal pulsation, — but it
can not exist independently of the action of the foetal heart,
and when this can be detected it is of no use in diagnosis.
The foetal tic tac, or pulsation of the foetal heart, consists of
short, double, regular pulsation, resembling those of the
new born infants, varying in velocity from 120 to 140 in a
minute. This sound can not be simulated by, nor confound-
ed with any other ; so, when it can be distinctly heard, it is
proof positive, and the only one, of the presence of foetus;
where there is the tic tac, there must be a heart to produce
it, and where there is a heart. tht3re must be a foetus. Its
absence proves only negatively, that there is no foetus, or if
any, that it may be dead.

There is no known sign by which we can determine that
a woman is not pregnant. This fact makes this sign the

Eclectic and Summary, 275

more valuable, as in nearly all cases of actual pregnancy
with a living foetus, we may at once verify it. The foetal
tic tac, according to different authors, may be heard from
three and a half to five months after conception. The lo-
cation of the sound and the manner of obtaining it, we
need not indicate.

This sign alone furnishes the means of diagnosing twin
pregnancy, determining any thing in relation to the foetal
health, or the presentation to be expected when labor com-
mences. If, then, this is a true test, as we assume, how do
those physicians appreciate its value, who never auscult the
abdomen at all? What confidence ought to be placed in
the testimony of a medical witness in court, who should
base his opinion of pregnancy entirely upon those signs,
every one of which he knows to be equivocal ? No matter
what may be said of ballottement, aggregate signs, age,
experience, learning, they all vanish like vapor before the
sunbeam, when compared with this. We may be pardoned
then, if we exhort those who wish to be considered "read
up," and who still entertain "peculiar views," to study o5-
stetmcal auscultation by the bedside, study it, where alone it
can be learnt, on the abdomen of woman. — Western Lancet

When we wrote the review referred to in the following
article, we hadn't the most distant conception of receiving
a castigation. But we know that the profession will
thank us for having drawn from Dr. H., so good a paper as
that we find in the November number of the Nashville
Medical and Surgical Journal. For the benefit of our sub-
scribers, we transfer it to these pages, prefacing it with
these quotations. [Ed. Record.]

"The therapeutist ought to be a pathologist; the pathologist an anatomist
and physiologist; but independent observation is the sole foundation of our patho-
logical and therapeutical knowledge. — Jenner.

"The first deficiency which I think good to note, is the discontinuance of
the ancient and serious diligence of Hippocrates, which used to set down a
narrative of the special cases of his patients, and how they proceeded and
how they were judged by recovery or death." — Bacon.

Observation and Ratiocination — Facts and Principles — The
East Tennessee Record of Medicine and Surgery, by E.
B. Haskins, M. D., of Clarksville, Tenn.
"Let there exist then (and may it be for the advantage of both) two

276 Eclectic and Summary.

sources and two distributions of learning, and in like manner two tribes,
and as it were kindred families Of contemplators, or philosophers, without
an y hostility or alienation between them ; but v rather allied and united by
mutual assistance." — Bacon.

Observation and reason are two great intellectual powers
that man has ever, in some way, exercised, in the investiga-
tion of the objects and phenomena which constantly surround
him.

These two great powers, however, do not generally ex-
ist in a uniform and equal relation in different persons.
The great mass of mankind possess these two powers in a
Very unequal state of development. In some, reason pre-
dominates ; whilst in others, observation holds the ascen-
dency. And as each mind views its own impression of
things as the correct standard of truth, it can not he surpris-
ing that the intellectual world should be divided with re-
gard to the relative value of facts and principles ; and that
differences should arise as to whether observation or reason
be the legitimate agent of investigation. It can not be
surprising that he who is endowed with a large share of ra-
tiocination — forgetting the origin of those facts upon which
the basis of reasoning must rest — should in the pride of his
self-sufficiency, hold in intellectual iuferiority his less con-
templative, though more observing neighbor. And on the
other hand, that he who is enriched with a preponderating
share of observation, should look with distrust upon those
philosophic gems brought up from the depths, the plummet
of whose wisdom is too short to fathom. Nor is it surpris-
ing that disputes should arise between them; and that they
should strive to array the cultivators of science in hostile
parties, each claiming the whole field of research as its
rightful domain, denying all right and interest to the other,
and that medicine, embracing as it does an art, deriving its
great principles from so many sciences, should be the ground
upon which those parties are wont to display their strength.

But happily for the interest of learning, a few exist, pos-
sessing that equal and harmonious development of the in-
tellectual powers, which enables them to see things as they
are — who by a proper regard for both facts and principles,
and a due respect for both reason and observation, keep
those, belligerants in that respectful relation that constrains
then to become equal contributors to the progress and per-
fection of science.

Eclectic and Summary. 277

These reflections have been suggested by the following,
which I take from a review of the "Proceedings of the
twenty-third annual session of the Medical Society of Ten-
nessee, held at Murfreesborough, May, 1852," in the East
Tenn. Rec. of Med. and Surg, for August, 1852.

"One of them, whose energy and ability as exhibited in these transac-
tions much incline us to regard him with great respect, used language
conveying an idea that we are almost sure he did not intend. What im-
ports it *if an opinion does prevail in the west, Jhat western physicians
can only report cases ?' Are we therefore to leave^he field ot observation
and launch fearlessly upon the billows of hypothesis and free discussion?
Shall we, like Brown, Broussais and others, sefze hold of some great fact,
or leading observation, and indulge in specious argumentation, giving full
play to ihe imagination, fill pages or volumes with language poetically
beautiful, give nothing a local habitatiop-and a name, and call it essaying,
elaborating a system ? * * * Though, observations have been record-
ed for many hundred years, very few, if any general principles have been
established in medicine, and until this can be done, any attempt at essay-
ing them, will be illegitimate, however much of a genius the attempt may
prove the essayist to be. * * * *

* * "It is then, in our opinion, unfortunate that any remark should
have been made, and especially by one who must exert an extensive in-
fluence, which in any degree depreciated the value of observing and the
importance of recording observations. 5 '

The remarks made in the Society calling forth the rhap-
sody, if I may so speak, from which these extracts are taken,
are thus reported in the Nashville Jour, of Med. and Surg.,
July, 1852.

"Dr. Haskins thought the Society was under obligations
to the author of the paper which was of much interest. He
liked to see principles — great principles discussed — essays
written, &c. An idea prevailed in the west, that western
physicians can only report cases. He thought western men
possessed the talent and information to do more than this,"
&c.

Now if the learned editor gets the "idea" from these re-
marks, (as I certainly understand him to do) that we are "to
leave the field of observation and launch fearlessly upon the
billows of hypothesis and free discusssion," "indulge in spe-
cious argumentation, giving full play to the imagination,"
"fill pages with language poetically beautiful," &c, &c,
then I can certainly assure him that I have "used language
conveying an idea" that I "did not intend ;" and my only
hope of escape is that the editor is singular in his under-
standing.

278 Eclectic and Summary.

But what if the editor, in his zeal to defend the "value of
observing and the importance of recording observations,"
should prove to be the greater enemy to the cause he at-
tempts to defend? What am 1 to understand from the de-
claration that "though observations have been recorded for
many hundred years, very few, if any general principles
have been established in medicine" ? Am I to understand
that it is not a principle — aye, and & general principle in the-
rapeutics, that Opium allays pain and quiets agitation? —
that blood letting curtails the duration of acute inflamma-
tion ? — that Ipecac vomits ? — that Castor Oil purges ? Am
I now for the first time to learn that of all those great prin-
ciples of pathology and therapeutics which have governed
the medical profession so long, but "very few, if any," are
established ? I had thought better of the "value of observ-
ing and the importance of recording observations." I yet
think that observation, together with experiment, has es-
tablished many general principles in medicine, in physiolo-
gy, pathology, therapeutics and hygiene.

As no exact analogies can be found, so as to make each
recorded case guide us in the management of an analogue,
the chief value of observations seems to be that of estab-*
lishing general principles. Hence the importance of num-
bers and accuracy, to provide the principles general.

The term general, however, as applied to lawsor princi-
ples, is used by writers in a very latitudinous sense. As ap-
plied to pathology it is sometimes used to embrace only
those principles belonging to disease in its most general
signification. In this sense Chomel uses the term. Or it
may be applied to principles extending over groups or class-
es of disease as Inflammation, Fever, &c. In this latter
sense, most other writers, as Alison, Louis, Williams, Stille,
Simon and others use the term. The same is true of thera-
peutics. We may treat of general therapeutics, embracing
only those principles of treatment belonging to disease in
its widest sense, or we may treat of the general therapeutics
of Inflammation, Fever, or any other group of diseases.

With this hasty and imperfect exposition of my idea of
principles in medicine, I trust I may not be regarded obsti-
nate if I reassert that "I like to see principles — great prin-
ciples discussed."

And now that the weight of my humble influence may
not, in the slightest "depreciate the value of observing, and

Eclectic and Summary. 279

the importance of recording observations," I beg leave to
close this paper with the following extract from a publica-
tion 1 made more than twelve months ago. [See Western
Journal of Med. and Surg., for January, 1851.]

"That the difficulties attending private practice may be
so far overcome, by persevering industry, as to enable the
practitioner to record his more interesting cases in such a
manner as to benefit himself, will not be argued here, as no
one will, for a moment, doubt such a proposition. It may
not, however, be so readily granted, that their publication
amidst such a tide of hospital reports as flows through
the periodical press at present, can, in any appreciable de-
gree advance the interests of medicine. Yet it will hardly
be denied that whatever is of individual, may be of general
interest — that if it be uselul to the individual practitioner to
record his cases for the assistance of his own memory, and
thus acquire the largest amount of experience in the shortest
possible time, that therefore the same benefits will accrue to
others who may avail themselves of such experience. The
same rule holds in this case, as in that of hospital practice ;
with this difference, however, as regards the relative impor-
tance, the private practitioner must content himself with an
humbler, but no less responsible share of clinical literature.
Instead of aspiring to govern professional opinion by exten-
sive monographs of special observations, he must content
himself with furnishing such scattered materials as fall
within the scope of his more diffuse labors ; instead of es-
saying to erect a temple, to his own fame, he must be satis-
fied with a niche in the great common temple, of which he
can but act as an humble co-builder. To this subordinate
end, however, it can not be disguised, that industry, honesty
and capability are absolutely essential — without these re-
quisites, clinical reports are mere trash, that only clog the
literature and embarrass the science of the profession, with-
out the possibility of giving other than a brief notoriety to
the author."

280 Eclectic and Summary.

"We cheerfully comply with the hope of the editor of the New York
Scalpel, that the facts asserted by him in the following article, published in
his number for November, will be extensively copied by other journals.
The viciousness of poor fallen humanity, illustrated in bargain and intrigue
between medical practitioners and the clerks, office attendants, or even pro-
prietors of Hotels, should be published in a form suitable for distribution
on the railroad cars, steam boats and ships, for the benefit of the thousands
who daily arrive at New York, and are liable to become the subjects of the
foul conspiracy which is here exposed. [Ed. Recohd.]

Hotel Practice in New York — An Infernal Abuse.
"He was a stranger and we took him in."

The abuses of our profession demand the eyes of Argus,
and the arms of Briareus. If father Jupiter paid that old
coon for guarding Io no better than our brethren pay us for
watching over their characters, we don't wonder Apollo
has given so large a number of them to the devil. It would
seem that "respectable gentleman in black" (we think our
brethen have selected a most appropriate color for their
dress.) has given them special counsel in getting up the sys-
tem of practice at present pursued in the "Hotel Practice"
of our city. The cookery and ventilation in these "mag-
nificent establishments," together with the refined and fas-
tidious palates of a large portion of the traveling public, af-
ford uncommon facilities for practice upon their bodies and
their pockets. The physician who has given a philosophi-
cal glance at the valiant trenchermen engaged at their
suppers on board a North River steam boat, and then, after
fortifying his stomach with a glass of brandy-and- water,
and his nose with a piece of camphor, descended into that
''inferno," the lower cabin at midnight, has had a practical
idea of the facilities for "Hotel Practice." On board the
boat, the patient spends but one night ; at the Hotel usual-
ly several ; he is generally ready for practice by the third
nighX, when the operation commences. Nine out of ten of
the cases of sickness at these places are Cholera Morbus,
demanding no more than a purgative, with a little Lauda-
num, or tinct. Hyosciamus, fresh air, and a little light soup ;
but getting considerably more, as you shall see. The mod-
ern discoveries in "Hotel Practice" may be of service to
our country readers; if editors will give the hint, ihey will
probably get no drinks gratis when they come to the city.

A violent pull at the bell summons the porter, who is
requested to bring a doctor immediately ; he may possibly

Eclectic and Summary. 281

be asked to bring a gentleman of character ; 'tis all one,
however, he has received his cue from the bar-keeper, be-
tween whom and the doctor there is "an arrangement."
He assures the gentleman, in the midst of his writhings and
groans, that Dr. Snooks is one of the first medical men in
the city, whose skill has often been tested in the house ;
the Esculapian is summoned, and is soon at the bed-side.
The sick man being in an admirable condition to acknowl-
edge sympathy, receives it in abundance, and at suitable
intervals a few Calomel pills, and occasional reminders of
the necessity of "doing something" at a lower portion of
his intestinal tract. He is regaled at suitable intervals
with a joke, a little Laudanum, and Peppermint or Cam-
phor, with a few drops from a wonderful little bottle, which
the doctor takes from his side pocket ; he is learnedly in-
formed that the "primas viae must be cleared out." This is
very satisfactory, and convinces him of the doctor's intelli-
gence. The window is judiciously closed, for fear of his
"taking cold." The doctor end ures the poisoned atmosphere,
which has mainly produced the attack, by the aid of an oc-
casional escape and visit at the bar, or a drink from his
pocket pistol, and a walk in the hall. Towards morning, if
nature be merciful, and the pills be retained, relief follows.
If the patient were now let alone, and could get a little fresh
air, some clean and simple meat broth, and the attention of
a mother, a wife, or a sister, he would be out next day ; —
but this is no part of our philanthropist's plan ; it wouldn't
pay house-rent and horse-keep, and servants' hire. He is
therefore well dosed for three days, to overcome "the ten-
dency to inflammation of the bowels; "mustard plasters are
liberally used, and he may thank heaven if he escapes leech-
ing and blistering. When he evinces a disposition to bolt,
and relates his former experience in a similar case, where
he was not so fortunate as to meet with any one but nis poor
country doctor, (who, of course, knew nothing, and had only
one old horse, and neither rent nor servants to pay,) he is
frightened with tales of the "epidemic condition of the air
in the production of dysentery, and several severe cases now
under treatment," &c, &c, with the story of Mr. So-and-so,
who "was doing very well till he insisted on going home,
where he speedily died," &c, &c. Another week's treat-
ment with tonics, is the consequence of this rascality, and
a bill of 850 or $75, per centage to the bar-keeper off.
Those who come to the city with chronic diseases, desir-

282 Review,

ing to submit to the treatment of some gentleman previously
selected, generally escape this miserable rascality ; by no
means, however, without hints and inuendoes of the supe-
rior skill of their favorite physician, who may, however,
never in his life have seen or treated such a case as the one
at hand. There is not a practical man in this city, of any
character, who is not perfectly aware of the truth of this ex-
pose, and we most earnestly hope this statement will be ex-
tensively copied. Our editorial friends could not better serve
the cause of humanity. More of this anon.

KEVIEW.

Elements of Chemistry, by Thomas Graham, F. R. S., Pro-
fessor of Chemistry in University College, London, fyc,
tyc. Second American, from an entirely revised and
greatly enlarged English edition, with numerous illustra-
tions ; edited, with notes, by Robert Bridges, M. D.,
Prof, of Chemistry in the Philadelphia College of Phar-
macy, &fC>; Philadelphia, Blanchard fy Lea, 1852.
There is no difficulty in finding booksellers, who are
willing to risk the publication of the numerous small
books, with which the press of our country is so prolific.
But* larger works, treating more minutely on abstruse scien-
tific subjects, and which benefit the public more than the pub-
lisher, often undergo serious delay before obtaining a bidder.
We are, therefore, much indebted to the enterprising pub-
lishers, Blanchard & Lea, for supplying, or rather, for first
creating the demand, by spreading before the public an
American edition of Graham's Elements of Chemistry. The
first English edition contained omissions and errors, which
were supplied and corrected under the editorial care of that

Review. 283

talented and able chemist, Robert Bridges. The second
English edition, published in numbers, did not embrace all
the discoveries made before the work was completed ; we
are, therefore, again offered, by the same obliging firm, a
new and superior American edition, brought down to the
present year. For t the general student of chemistry, this
treatise as a whole, is no doubt, the most desirable work ex-
tant. The high character of Prof. Graham, as a chemist,
and the ability of the American editor, afford sufficient ev-
idence of the merit of the work, while the ready sale procur-
ed for the first edition, and the demand for a second evince
its adaptation to the wants of the student.

With these few words we might close our remarks, but
we can not resist a strong inclination to notice the work
more particularly — since it treats on a science of surpassing
interest, and which is susceptible of so many applications of
utility.

How appropriately has the learned author devoted the
first chapter to the subject of Heat. Its agency in the vast
laboratory of nature is so extensive and apparent that the
most careless examination of the properties of matter, dis-
covers it existing in every conceivable variety of forms,
from solids to liquids and gases. By a variation in the in-
tensity of this agent, the same compound is manifested in the
solidity of an iceberg, the soft mobility of the flowing brook
or the vesicular masses supported by the atmosphere or
wafted by the breeze. Under the influence of a specific
amount of heat, platina and gold are the most dense solids
known, but when this amount is increased to a certain ex-
tent they are converted into a liquid state, while a greater
intensity dissipates them in the form of vapor.

In this chapter the general law, that all bodies expand
when heated, and contract on cooling, is carefully investi-
gated in reference to solids, liquids and gases. This in-
vestigation embraces a summary of profound scientific re-
search and important practical deductions, rarely contain-
ed in the same compass. In speaking of the principle aqd

284 Review.

construction of thermometers, the author refers to causes
of inaccuracy in these instruments which no doubt serious-
ly affect a large majority of those sold in this country.
Thermometers which are properly closed and contain no air,
can be inverted without injury, and the mercury falls into
the tube, producing a sound as water does in the "water-
hammer." When the instrument contains air the thread of
mercury is apt to divide on inversion and also from other
causes. Some thermometers with very thin bulbs, although
free from air, are liable to error, "supposed to arise from
the pressure of the atmosphere upon the bulb, which when
not truly spherical seems to yield slightly and in a gradual
manner." The use of different scales in graduating ther-
mometers is not unfrequently an inconvenience in compar-
ing the results of observations. The author appears to pre-
fer the decimal system or the Cutigrade scale of Celsius. It
is certainly more simple since its adoption involves no the-
ory and is founded on the long observed and well known
facts, that water freezes and boils at fixed temperatures.
But Fahrenheit's thermometer, which heretofore has been
used most extensively in England and almost exclusively
in this country, has its zero 32 deg. below the freezing
point of water. As he kept his process of graduating ther-
mometers secret, different reasons are given for the princi-
ples that guided him in the adoption of his scale. We know,
however, that his zero was placed at a temperature indica-
ted by the most powerful freezing mixture known at that
time — a mixture of salt and snow — and it is asserted that
he' selected that as a starting point under the assumption of
its being entirely devoid of heat. But later experiments
show the incorrectness of the assumption — a mixture of so-
lidified carbonic acid and ether, placed under the receiver
of an air pump, reduces the temperature 166 deg. below his
zero, — and Natterer has lately succeeded in reducing it
54 deg. lower, or 250 deg. below the freezing point of wa-
ter.

Review. 285

In explaining the principles of chemical philosophy,
wherever the nature of the subject permits, the author first
presents facts and experiments, and by these demonstrates
the truth of his hypothesis, and the correctness of practical
inferences. This instructive method is especially charac-
teristic of the sections on Specific Heat, and on the Commu-
nication of Heat. The illustrations given, prove that each
body in nature possesses a capacity for a definite amount of
heat — that to elevate its temperature through any specified
number of degrees always requires the same amount to be
absorbed, and that when its temperature is lowered a corres-
ponding amount of heat is evolved. Of all solids or liquids,
it appears that water has by far the greatest capacity for
heat, a fact which enables us to appreciate more fully the
influence of the ocean upon the climate of maritime coun-
tries. In the beautiful language of Mr. Graham — hence,
the sea which covers so large a proportion of the globe, is a
great magazine of heat, and has a beneficial influence in
equalizing atmospheric temperature. Mercury has a small
specific heat, so that it is quickly heated or cooled, another
property which recommends it as a liquid for the thermome-
ter, imparting greater sensibility 'to the instrument. We
would notice also that the specific heat of gas, or the atmos-
phere is greatly increased by rarefaction. The rays of a
summer sun would be insupportable even in our own north-
ern latitude, did they not expand the atmosphere and large-
ly augment its capacity to contain latent heat, while in
winter the contracting tendency of cold causes it to evolve a
very perceptible portion of heat.

The section on Radiation contains a number of interest-
ing facts acquired by means of a beautiful apparatus con-
trived by Melloni, and called a thermo-multiplier. This in-
strument, in its construction elegantly illustrates the appli-
cation of philosophical principles ; and in delicacy and im-
portance it is scarcely equalled by any other yet desired for
physical inquiry. It consists of forty or fifty bars of antimo-

286 Review.

ny and bismuth arranged alternately, separated by some in-
sulating substance, and soldered at their extremities. To
the first and last bars, copper wires are attached and then
connected with an extremely delicate magnetic needle.
When one extremity of the bundle of bars is exposed to
any source of radiant heat, an electric current passes
through the wires and causes the needle to deflect. This in-
strument is so sensitive as to indicate readily a variation of
the two-thousandth part of one degree of Fahrenheit. It is
said that the needle may be affected by the heat of a man's
face at the distance of a league. In trials made with it up-
on the disk of the sun, the heat near the border was found
to be only half that of the center ; and in trials made upon
the spots, there was indicated a sensible reduction of tem-
perature. From researches made with an instrument of
such remarkable sensibility we have reason to expect many
interesting results. Nearly all the information we possess
on this branch of science was revealed by the aid of this
valuable apparatus of Melloni.

Vaporization is a general term used to denote the conver-
sion of liquids or solids into vapor. Water, alcohol, turpen-
tine, mercury and various other substances emit vapor at
nearly all temperatures. The amount of vapor given off and
its expansive power are increased and diminished with the
temperature and upon a knowledge of the laws which regu-
late this production and tension of vapor, depend some of the
most important contributions that science has ever made
to the arts. Perhaps no single experiment furnishes more
satisfactory data for investigating the laws of vaporiza-
tion, than the one which is given— if a thermometer be plung-
ed into water and the point marked where the mercury
stands at the commencement of boiling, it will be found to
rise no higher, although the ebullition be continued. The
heat required to sustain the ebullition is carried off and be-
comes the specific heat of the steam, which acquires no high-
er temperature than the water, although J 000 deg. of heat

Review. 287

be absorbed. One gallon of water converted into steam is
capable of raising the temperature of 1000 gallons to the
boiling point, a fact which proves that the heat absorbed is
retained in the steam. Although water boils at a lower
temperature when atmospheric pressure is removed, yet
the specific heat of the vapor is the same. In the process
of refining sugar, and in the preparation of many other
vegetable extracts, which are liable to be discolored,or have
their properties injured by a higher temperature, the evapo-
ration is conducted at much lower than 212 deg. in a
vacuum. Water can readily be made to boil at 100 deg. or
even less, in a good vacuum; but the expense of fuel is by
no means diminished, for if the temperature is lower the
vapor is more expanded, and consequently its latent heat is
increased in proportion. The sensible and latent heat of
steam, therefore, always amount to a constant quantity,
whatever be the pressure. That constant quantity is 212
plus 1000, the latent heat of steam. When the temperature
of steam is only 100 deg., its latent heat is, 1212 minus
100 deg., if the temperature is that acquired when genera-
ted under a pressure of thirty atmospheres, or 457 deg., the
latent heat is 755 deg. Especial reference has only been
made to steam ; but the latent heat of other vapors, as that
of alcohol, ether, oil of turpentine has been found to vary
according to the same law.

"I can not bear to hear every person speaking well of
Aristides," said one, when requested to assign his reason for
the ostracism of that man, whose virtues have associated
with his memory through all succeeding time, the enviable
title of "The Just." However unwilling we may feel, or
humiliating it may appear to award to a single individual
the merit of superior knowledge in every department of
science ; there is scarcely a chapter in chemistry in which
we are not required to acknowledge our indebtedness to the
labors of Faraday. He has been pre-eminently successful

288 Review.

in confirming his theories by direct experiment. That per-
manent gases, like steam, owe their elasticity to latent heat,
was long suspected, but could not be verified until Faraday
succeeded in his celebrated experiment of effecting their
condensation. Since he has shown the process for sub-
jecting carbonic acid, sulphurous acid, and other gases, to
pressure and cold, it is no unusual experiment to see them
reduced to a solid or liquid state, and afterwards employed
as freezing mixtures of such efficiency, that water and mer-
cury are not only congealed at ordinary temperature, but
they may be actually frozen in red hot crucibles. Great
pressure and cold are not always required to liquify gases.
These experiments of Faraday have given importance to
several apparently insignificant circumstances, which now
lead to the conclusion that "all gases whatever are absorb-
ed and condensed by water in a greater or less degree, in
which case they certainly assume the liquid form. 1 ''

Passing overmuch interesting and important matter, we
will notice the application of this remark of the author, to
the passage of gases through membranes. It affords a
more philosophical explanation than has hitherto been giv-
en of several phenomena in the animal and vegetable king-
dom, and particularly of the process, imbibation and tran"
spiration of gases during respiration. "If a bladder half
filled with air, with its mouth tied, be passed up into a large
jar filled with carbonic acid gas, standing over water the
bladder, in the course of twenty four hours, becomes great-
ly distended by the insinuation of the carbonic acid through
its substance and may even burst, while very little air
escapes outwards from the bladder. This result depends up-
on two circumstances; first, upon the carbonic acid being a
gas easily liquified by the water in the substance of the
membrane — the carbonic acid penetrates the membrane as
a liquid ; secondly, this liquid is in the highest degree vola-
tile, and, therefore, evaporates very rapidly from the inner

Review. 289

surface of the bladder into the contained air." Precisely
the same phenomena are exhibited when other gases are
employed, some of them permeate membranes more rapidly
than carbonic acid, and others require a greater length of
time. In this manner, during respiration, oxygen is intro-
duced to the blood, and in the same way the gaseous pro-
duct passes through the membranes and is thrown off by
the lungs.

The diffusion of vapor in the air is treated in a manner
which must be highly satisfactory to the purely scientific
inquirer. Knowledge may be esteemed valuable, because
it approximates man to the divine image of the Creator;
but it possesses another importance more allied to earth
than celestial images — that of supplying human wants and
of meliorating the incidents of human life. In conducting
hvgrometric observations, it is, indeed, a beautifnl and deli-
cate experiment, to measure the humidity of the atmosphere
and render visible the attenuated vapor which expands un-
seen into the regions of space. The labor of the philoso-
pher may be ended when his long hours of investigation
have led to the discovery of principles and facts, and in the
plenitude of his joy he may exclaim, Eureka ; but an un-
appeased spirit of humanity will still inquire, "cui bono?"
and seek their application to some purpose of utility. Phy-
sicians, I believe, fully appreciate the influence of a dry or
moist atmosphere in the treatment of many pulmonary and
cutaneous diseases ; but, 1 do not know any one who applies
the principle to practice unless it is in advising a change of
climate. By the use of a properly constructed hygrometer
the invalid, who from his circumstances, avocation,or famih'
ties, is unable to change his locality, can regulate his apart-
ment to any desirable degree of humidity, and can thus at
home enjoy with perfect uniformity all the advantages of a
moist sea breeze, or a dry mountain air. Mason's hygrom-
eter is the simplest instrument, of the most modern* con-
struction, and is better adapted for this purpose than any

290 Review.

with which I am acquainted, while it constantly indicates
the temperature, dryness and humidity of the atmosphere,
with the utmost accuracy. If the apartment is too dry it is
easy to supply and maintain any amount of vapor required
by evaporation from a kettle, and this instrument will point
out the precise degree of humidity attained. If the air is
too damp, it can be brought to the required dryness by ele-
vating the temperature of the room, or by resorting to the
use of any of those substances which absorb vapor rapidly.
The indications of the barometer are so much influenced by
the humidity of the atmosphere that in making observations
with it, corrections should always be made for the tension
of vapor of the air, as well as for temperature.

The chapter on Light is quite short, as the author enters
into no discussion of theories on this subject, but presents a
synopsis of the most prominent facts, illustrating the prop-
erties of light. Among the facts mentioned we will only call
attention to the dark lines, or interruptions observed in the
spectrum. All the light which emanates from the sun,
whether it comes directly from that luminary, or reaches us
by reflection from the moon or planets, is distinguished by
certain notable dark lines. Artificial light is characterised
by different lines and shades, while the light which proceeds
from the fixed stars exhibit other marks equally charac-
teristic. The cause of these peculiarities is supposed, with
some show of reason, to be owing to the nature of certain
gases peculiar to the atmosphere of each luminary. In
view of the results to which the investigation of this discov-
ery may lead, the author remarks that "we thus may yet
have it in our power to study the nature of the combustion
which lights up the suns to other systems." From the late
discoveries relative to the chemical rays of light — the pow-
er of these rays in promoting certain decompositions and
combinations, and from the long-known and well-marked
influence of light on numerous organised bodies, there is
certainly much ground to hope that new and important

Review. 29 1

accessions will be made to this branch of knowledge.
No science has been so fortunate in the acquisition of an ap-
propriate system of names as chemistry. The nomenclature
and notation first suggested by Morveau and introduced by
Lavoiser have been, beyond all other means, the great cause
of promoting the advance and diffusion of chemical knowl-
edge. In some other branches of learning the memory of the
student is liable to be overburdened and his mind perplexed
with a mass of uninteresting technicalities, which a volume
is required to define — but in chemistry, when the student is
familiar with the names of the elements, a few words of
explanation will teach him how to designate any known
compound, and how the name of any combination at once
suggests the elements and their proportion. But, for full in-
formation on this subject, together with an elucidation of
the beautiful laws of chemical affinity, the doctrine of equiv-
alents, the imposing theory of atoms, and the volume theo-
ry of gases, no work published in this country surpasses
"Graham's Elements."

Some subjects, apparently unimportant, excite curiosity by
their obscurity, and their study is thereby rendered more in-
teresting than if they were well understood. The term Alla-
tropy, has been applied, by Berzelius, to a class of phenom-
ena of this character. A great law of physics announces,
that "no change of properties can occur without a change
of composition." Sulphuret of mercury, when prepared by
one method is black, but by another it is vermillion, yet the
composition of each is the same. Chromate of lead is usu-
ally yellow, but if it be fused and thrown into cold water it
is red. Several silicates on cooling, from a state of fusion,
invariably crystalize, yet, when a mixture of the same sili-
cates is fused they appear, invariably, to loose the faculty of
crystalising. Arsenic acid, when first sublimed, is transpa-
rent, after cooling some time, it becomes opaque. The
color of many substances, when warm is different from that
which they exhibit when cold. A number of compounds, as
peroxide of allumina, sesquioxide of chromium, &c, which

292 Review.

readily dissolve in acids before, lose their solubility after be-
ing heated to redness. As no change can be discovered in
the composition of any of these substances, there is some
difficulty in accounting for the change in their properties,
since the color, crystalization, opacity and solubility are
all affected. The only circumstance which can suggest any
explanation of these apparent anomalies, is that such sub-
stances do not contain the same amount of specific heat be-
fore and after this change in their properties.. The ponder-
able constituents all remain precisely the same, but the
amount of latent heat is increased or diminished. Should,
therefore, the well-known law, above referred to, be aban-
doned ; or shall heat be regarded as an essential constituent
of bodies, and of course capable of affecting the properties
and composition of matter ?

Of all that portion of Dr. Graham's valuable work,
which is devoted to ah exposition of the doctrines of chem-
ical philosophy, no section surpasses that which relates to
the constitution of Salts. It embraces about twenty pages,
and supplies an amount of information not only on the gen-
erally received theory, but, also on that more latterly adopt-
ed, by Prof. Daniell and some other able chemists. To the
more advanced student, this section alone is worth the en-
tire cost of the work, because it supplies a desideratum in
all the English or American text books, which have fallen
under my observation.

Different kinds of matter appear to possess attachments
or aversions for each other, and this properly has been call-
ed affinity. Whatever explanation may be given as to the
origin of these specific "attachments, and aversions," they
must be admitted as the cause of chemical combinations.
The chapter on Chemical Affinity describes the various
means of promoting combination, with clearness and pre-
cision. In addition to the known cause of affinity, a pecu-
liar class of combinations is arranged under the head of Ca-
talysis. The new form of force described under this term,
"may prove only a convenient fiction, and the occasion for

Review, 293

its use ceases, as the science advances." If, however, the
phenomena which it classifies have been correctly reported
— that one body, merely by contact, can resolve others into
new compounds — I cannot avoid regarding it as the outcrop-
ing of a rich vein, whose hidden treasure science will here-
after reveal.

The pages devoted to Chemical Polarity, contain much
information ; but this subject has, within the last few years,
grown to such an importance as to require almost of itself,
an entire volume. It may be regarded as too presuming
in us to find fault with any portion of Prof. Graham's work
— but how it is possible to crowd into so small a compass as
he has attempted, all that is important or even essential for
the student to understand, of Polarity, Simple and Compound
Voltaic circles, Solid and Liquid elements of the circle, mode
of Electrolysis, Thermo-electricity, Magnetism, Diamagnet-
ism, forms of Voltaic instruments, &c, is more than we can
understand. The author would not,of course, overlook the re-
ports and proceedings of learned societies ; but he has cer-
tainly failed to notice facts of no small moment, reported in
monographs. In other portions of the work, also,"the appli-
cations of the science to the arts" was, generally, highly
gratifying ; but in this connexion, processes which have
been deemed worthy of the encouragement and patronage
of the British government, and also of our own ; applica-
tions in which already thousands are engaged, and which
are constantly gaining importance, are scarcely mentioned.
The only consideration which occurs to us, that could have
prompted an omission of many instructive properties, and
numerous interesting applications of electricity excited by
chemical agency, is the extent to which their full examina-
tion would lead. In another part of the work there is an
omission which could not be referred to the same considera-
tion, and which will, no doubt, be supplied in future editions
of the work. The reactions of nearly all the metals before
the blowpipe, are so characteristic, that without a notice of
them, we could scarcely consider a work on chemistry com-
j

294 Review.

plete. The section on Sodium, contains some directions on
the use of the blowpipe, but they are insufficient to impress
the mind of the student with an idea of the importance of
this useful instrument, much less teach him its skillful use.
In determining minerals, no method is perhaps so correct
and expeditious as that of the blowpipes; it is, therefore, cer-
tainly desirable that the description of each should also set
forth its behavior before the blowpipe.

The fifth chapter commences the examination of the
properties of elementary bodies. Instead of the "four ele-
ments of ancient philosophers," we can now number sixty.
two, but only a small proportion of them enters into the com-
position of the great mass of materials which form our
earth, and some of them are so rare that few chemists have
examined them.

Many reasons might be given for the propriety of the clas-
sification which the author has adopted, and also for the or-
der in which he has treated the elements, but the arrange-
ment will, no doubt, prove satisfactory to the student, if not
to the speculative chemist. This portion of the work bears
ample evidence of being the production of one, who is prac-
tically as well as theoretically, familiar with the most mi-
nute details of his subject. In several popular text books on
chemistry, used in this country, certain processes given for
performing experiments, are highly faulty, important direc_
tions being omitted, or cautions given that were not required.
None but a practical as well as scientific chemist could por-
tray so clearly all the manipulations required for the nu-
merous and elegant experimental illustrations with which
this part of the work abounds.

As this science is constantly being enriched by the devel-
opment of new facts, the value of ''Graham's Elements" is
much enhanced by the additions of the American editor.
For the purpose of exhibiting the character of these addi-
tions, and also making known more generally, the beautiful
process of preparing anhydrous nitric acid, the following se-
lection is given.

Review. 295

[Anhydrous nitric acid was first prepared in 1849, by M.
Deville, by treating dry nitrate of silver with dry chlorine.
The nitrate of silver is placed in a U-tube, to which a sec"
ond, having a spherical reservoir at the curved part, is at-
tached. The first tube is immersed in a vessel of water,
which can be heated, by a spirit-lamp, and the second in a
freezing mixture. Chlorine is evolved and passed, first
through a tube containing chloride of calcium, then another
filled with pumice-stone, moistened with sulphuric acid, that
it may be perfectly dry before it reaches the nitrate of silver.
All the joints are united by the blowpipe. The nitrate of
silver is heated to 356 deg. F, and a stream of carbonic acid
passed through the apparatus to dry the salt, after which
it is allowed to cool, and the chlorine is transmitted. At
common temperature there is no appearance of action, but
when the heat is raised to 203 deg., and then lowered to
between 135 and 155 deg., decomposition takes place, chlo-
ride of silver is produced, and crystals of nitric acid begin
to appear in the second U-tube, at the part not immersed in
the freezing mixture, and a small quantity of liquid condens-
es in the spherical reservoir, while oxygen and chlorine
gases escape. To transfer the nitric acid, the stream of
chlorine is replaced by carbonic acid, and the freezing mix-
ture taken away, the liquid is now removed from the
resevoir and a bulb attached to receive the anhydrous acid.
This bulb is immersed in the freezing mixture, and the acid
evaporating at ordinary temperature condenses in the bulb,
which when filled is to be sealed by the blowpipe.

Properties. — Anhydrous nitric acid forms transparent col-
orless crystals, belonging to the right rhombic system. It
fuses at a little above 85 deg., and boils at about 113 deg.,
decomposing slightly at that temperature. In contact with
water, it dissolves with the evolution of much heat.

At ordinary temperature it is liable to spontaneons de-
composition, and bursts the bull) by the increased tension of
the confined gases. — R. B.]

NOTICES.

"Proceedings of the National Pharmaceutical Convention,

held at Philadelphia, October 6, 1852."

We are gratified to learn from this publication that the
members of this convention formed a constitution and re-
solved themselves into a Society, under the name of "Na-
tional Pharmaceutical Association," and adopted a code of
ethics. The preamble to the constitution asserts that there
are too many engaged in the responsible vocation of Drug-
gist, and the practice of Pharmacy, who are not qualified, and
declares the object of the Association is the elevation of the
professional character of apothecaries and druggists through-
out the United States. The constitution defines who shall
be eligible to, and how membership in the Association shall
be attained ; and designates officers, times of meeting, &c.
The code of ethics, though short, is too long for insertion
here. We must not omit, however, to mention that the
code discountenances "secret formulce and the practices aris-
ing from aquackish spirit" We commend the Association
to our interior druggists and apothecaries, as eminently
worthy of their consideration.

Summary of the Transactions of the College of Physicians,
of Philadelphia, from August 4, to October 6, 1852. Lip-
pincott, Grambo fy Co., $1 00 a year.

Tins quarterly is eminently adapted to the wants of those
who are constantly crying for something more practical, it
being almost wholly composed of the personal observation
and deductions of the members of the college — the most in-
fluential and best physicians of the city of Philadelphia.
The subjects discussed at the various meetings, of which
this publication is the record, were Dysentery ; Quinia in
large doses in the treatment of Typhoid Fever ; (won't do.)
Laryngitis ; Ulcer in the Pharynx, opening into the carotid

Notices. 297

artery ; Insanity. It is certainly a very cheap periodical,
the matter of the four numbers being of such a character as
may be advantageously referred to by the physician in the
discharge of hourly duty.

"Surgical Treatment of Polypi of the Larynx, and GEdema
of the Glottis, hy Horace Green, M. D., President fyc,
New York Medical College. G. P. Putnam, New York,
1852."

By the courtesy of the author (we presume) we have
been permitted to read this very important treatise. We
deem it important, because it places in bold relief an affec-
tion, to which but little attention has been given, and con-
sequently about which general practitioners know nothing.
"Amongst physicians of long experience and extensive op-
portunities for observation, not a few may be found who
will recall the occurrence of fatal cases in their own prac-
tice, when the patient, after having presented strange and
anomalous symptoms during life, died suddenly, from some
inexplicable cause. In some of these instances, it is not im-
probable that a polypus growth, gradually developed, in the
opening of the larynx, may have been the true cause of the
fatal termination." We commend the work to the favora-
ble attention of the profession.

The Physicians' 1 Visiting List, Diary, and Book of En-
gagements for 1852, Philadelphia, Lindsay 8p Blackiston.
This publication is an indispensable convenience to the
physician who has any extent of practice, and needs but to
be examined to be purchased. It contains blanks for the
names of twenty-five patients each week, addresses, wants,
etc., poisons and antidotes, and with it in his pocket, the
practitioner may feel secure in his being able to learn what
constitutes correct professional deportment, for he has but
to open it, and consult the best code of ethics that has ever
been compiled. We thank the publishers for our copy.
Price 75 or 50 cents, — two sizes.

EDITOEIAL.

THE PROFESSION AND THE PUBLIC.

'•The quackery which is practised among medical men is a much greater
evil than that which is abroad in the community." — Hooker.

"But since in so many directions, the teachers in the schools are ignorant,
the pupils raw, the instruction scanty, and the diploma a false certificate
the medical profession is infested with a horde of persons who have no oth-
er conception of it than as a trade, and who are entirely ignorant of those
precepts and principles," &c. — Hookers Reviewer.

"It is a fearful truth, that a physician ignorant of his profession, yet en-
gaged in the practice of it (and our country contains an abundance of such
culprits) does more mischief than almost any other character. The high-
wayman who only robs, and the felon who steals, are less guilty. The same
propensity, the love of gain, actuates each ; and each are alike unwilling to
seek it honestly." — Caldwell 7 s Valedictory.

Political editors have certain articles constituted of real
or presumed principles, and of positive or assumed facts
which they keep constantly in form, and headed, "Keep it
before the People." This head is not meaningless. It is a
broad assertion of the power of the people, as the proper
source not only of political, but of pecuniary and profession-
al dignity ; and with this appreciation of the general pub-
lic, we again present the same subject which we have so
very feebly preferred in the leaders of the preceding two
numbers of our journal. And if apology is necessary for
this course, which we follow both from desire, and a sense
of dut) f , it is furnished on our title page. The Record is
published under the auspices of the Medical Society of East
Tennessee, which had adopted the policy of attempting to
enlist the sympathies of the great public in the effort of phy-
sicians to rid the profession of unworthy practitioners, and
of course it is proper that the energies of the Record, how-
ever feeble at best, should be expended in enforcing the
correctness and wisdom of the policy.

We are fully aware of the difficulties to be overcome, but

Editorial. 299

are incited to renew the assault, and to redouble the blows
which we strike, confident that perseverance will produce
results, which want of original vigor failed to accomplish.

The greatest difficulty which we have to meet is in the
profession, and is manifested in the disinclination to pay that
regard to the subject under consideration which we think
it intrinsically demands; and in, the inevitable consequence,
an almost entire absence of any disposition on the part of
the members of the profession occupying places of influence
as professors, editors, and officers of Associations, to ma-
turely devise and deliberately adopt, any defined mode of
action, for the purpose of exposing ignorance and duplicity
in medical practitioners, so as to be known and read of all
men.

We have said, that so long as the public replenishes the
purses of those who presumptuously ask confidence as min-
isters to diseased humanity, just so long will the profession
be offended by impudence and the people be killed by the
timidity of disqualification, or by the bold daring of igno-
rance ; and an assertion which we, in the insignificance of
our obscurity, 'most certainly would never have ventured,
had we been at all doubtful of its truth. We again reite-
rate it, and in the spirikof "cry aloud and spare not," charge
upon physicians the fault which seemingly belongs to the
people. The errors of medical men are far more obvious
than the benefits and virtues which belong to the profession,
and the public is under present circumstances justified;
therefore, it behooves the profession, in its congregated
wisdom, to devise means by which professional capacity
may be appreciated, that the people may visit condemna-
tion upon individuals for errors, which are crimes when
committed from personal carelessness or ignorance, and
properly exercise charity for the defects that are inherent
to a vocation, which has to deal with such an abstrusity as
the union of spirit and matter, such a subtlety as the essen-
tial called life.

We presume that the subject of medical education has

300 Editorial.

never been so thoroughly discussed, as at the session of the
American Association, held at Boston, in the month of May,
1849. Dr. F. Campbell Stewart, the chairman of the com-
mittee, furnished the report through another member of the
Association, and, of course, was not present to take part in
the lengthy debate, to which the resolutions appended to his
report gave occasion. The resolutions were finally, on mo-
tion, referred to a special committee, composed of Dr. Ste-
vens, of the College of Physicians and Surgeons, New York,.
Dr. Wood, of the Medical Department of the University of
Pennsylvania, and Dr. Knight, of the Medical Department
of Yale College — honored, learned and skillful members of
the profession. Certain resolutions which had been for-
warded to the Association by the New York Academy of
Medicine, and a letter from Dr. John Watson, relating to
medical education, were referred to the same committee.
The appointment of this special committee was after the
debate, occasioned by the reading of the report, of the reso-
lutions of the New York Academy, and of Dr. Watson's let-
ter, and we must suppose that the conclusions of the spe-
cial committee were attained by considerate reflection, and
yet, when those conclusions were presented to the Associ-
ation, they gave rise to a prolonged, warm, though courteous
discussion. The report of the special committee was ulti-
mately adopted, as expressing the sense of the Association,
nevertheless the record, we must say parenthetically, is far
from conveying a just apprehension of the opinions held
by a.very large minority, if not in fact, by some who acted
with the majority of the members of that session. We
have made reference to the circumstances attending the
passage of the resolutions, which we intend to insert in this
article, that it may be seen they contain the cream of the
opinions held by the best educated minds in the profession
of this country, as to the attainments to be acquired by those
desiring to become physicians, and, as to the course proper
to be followed by those proposing to teach others the cycle
of sciences which constitutes a knowledge of medicine.

Editorial 301

The report of the special committee is embodied in reso-
lutions as follows.

1. Resolved, That the Association reiterate their approv-
al of the resolutions in reference to medical education adopt-
ed by the convention which met at Philadelphia in May,
1847, and contained on pages 73 and 74 of the published pro-
ceedings of that convention.

2. Resolved, That the attention of medical colleges be
again directed to the resolutions of the committee on pre-
liminary education, adopted by the Medical Convention, of
1847, and that they be advised to require from their students
that they shall in all instances present certificates of due
preliminary acquirements prior to graduation.

3. Resolved, That physicians, generally, throughout the
union, be advised and requested to require of those wishing
to become their pupils, evidence of a proper general educa-
tion, before admission into their offices.

4. Resolved, That the Association does not sanction or
recognise "College Clinics," as substitutes for Hospital
Clinical instruction, and that the Medical Colleges be again
advised to insist in all instances, where it is practicable, on
the regular attendance of their pupils, during a period of
six months, upon the treatment of patients in a properly
conducted hospital, or other suitable institution devoted to
the reception and care of the sick.

5. Resolved, That in accordance with a resolution of the
American Medical Association, adopted May 4, 18471, "it is
earnestly recommended to the physicians of those states in
which State Medical Societies do not exist, that they take
measures to organise them before the next meeting of this
Association."

6. Resolved, That the State Societies be reommended, af-
ter they shall have been organised, to recognise as regular
practitioners none who have not obtained a degree in med-
icine, or a license from some regular medical body, obtain-
ed after due examination.

7. Resolved y That the Association recommend to the va-

302 Editorial.

rious schools of medicine to meet at Cincinnati before the
next annual meeting of the Association, and present a plan
for elevating the standard of medical education to the As-
sociation.

The following resolution, by Dr. Bond, was adopted as
part of the above.

Resolved, That this Association recommend the encour-
agement of private medical institutions, strongly advising
that Dispensatory practice be made, as far as practicable,
part of the means of instruction.

The resolutions of the convention of 1817, which are "re-
iterated and approved" by the adoption of the 1st resolu-
tion of the special committee, are as follows.

Resolued, 1st. That it be recommencied to all Colleges
to extend the period employed in lecturing, from four to six
months.

2d. That no student shall become a candidate for the de-
gree of M. D., unless he shall have devoted three entire years
to the study of medicine, including the time allotted to at-
tendance upon the lectures.

3d. That the candidate shall have attended two full
courses of lectures, that he shall be twenty-one years of
age, and in all cases shall produce the certificate of his pre-
ceptor, to prove when he commenced his studies.

4th. That the certificate of no preceptor shall be received
who is avowedly and notoriously an irregular practitioner,
whether he shall possess the degree of M. I), or not.

9th. That the several branches of medical education al-
ready named in the body of this report, be taught in all the
colleges ; — and that the number of Professors be increased
to seven.

6th. That it be required of candidates that they shall
have steadily devoted three months to dissections.

7th. That it is incumbent upon preceptors to avail them-
selves of every opportunity to impart clinical instruction to
their pupils ; and upon Medical Colleges to require candi-
dates for graduation to show that they have attended upon

Editorial 303

Hospital Practice for one session, whenever it can be ac-
complished for the advancement of the same end.

8th. That it be suggested to the Faculties of the various
medical institutions of the country to adopt some efficient
means for ascertaining that their students are actually in
attendance upon their lectures.

9th. That it is incumbent on all schools and colleges
granting diplomas, fully to carry out the above requisitions.

10th. That it be considered the duty of preceptors, to ad-
vise their students to attend only such institutions as shall
rigidly adhere to the recommendations herein contained.

The resolutions of the convention of 1847, referred to in
the 2d resolution of the committee, are these.

1st. Resolved, That this convention earnestly recommends
to members of the medical profession throughout the United
States, to satisfy themselves, either by personal inquiry or
written certificate of competent persons, before receiving
young men into their offices as students, that they are of
good moral character, and that they have acquired a good
English education, a knowledge of Natural Philosophy and
the Elementary Mathematical sciences, including Geometry
and Algebra ; and such an acquaintance, at least, with the
Latin and Greek languages as will enable them to appre-
ciate the technical language of medicine, and read and
write prescriptions.

2d. Resolved, That this convention also recommends to
the members of the medical profession of the United States,
when they have satisfied themselves that a young man
possesses the qualifications specified in the preceding reso-
lutions,^ give him a written certificate, stating the fact
and recording, also, the date of his admission as a medical
student to be carried with him as a warrant for his recep.
tion into the Medical College in which he may intend to
pursue his studies.

3d. Resolved, That all the Medical Colleges in the United
States be, and they are hereby recommended and requested
to require such a certificate of every student of medicine

304 Editorial.

applying for matriculation ; and when publishing their an-
nual lists of graduates, to accompany the name and resi-
dence of his preceptor, the name of the latter being clearly,
and distinctly presented as certifying to the qualification of
preliminary education.

These resolutions contain the totality of the Association's
effort at reform. They have no reference whatever to the
multitudinous ideas which have been singly dignified with
titles, and called systems, and with which designing men de-
lude the credulous ; but are intended to affect the profession
of medicine, to engender a spirit of creditable emulation, and
induce the dissemination of knowledge and attainments
amongst men, who as a class, at one time appropriately re-
ceived the designative, learned. We, however, have al-
ways regarded the action of the Association as inadequate
to the attainment of this most desirable object. Indeed,
we think the influence of the resolutions will insure to the
growth, which is intended to be destroyed, a nourishment
that will enable the roots to take deep hold, and the vine
and the branches to thicken and extend, until the vitality of
the professional tree will be destroyed, and the parasite left
to revel in luxuriant greenness on the rottenness which it
has occasioned.

The resolutions contemplate a very material change in
the internal arrangement of Medical Colleges, based upon
an assumed essential value of the diploma which they con-
fer. This, in our humble judgment, is the material error
under which a very great number of our best educated
physicians labored, when they anticipated the moral weight
of the Association to effect so very much. They attached
a dignity and importance to the degree confered by the
Faculties of schools, which it can not essentially command,
and which, so long as the relations now subsisting between
the profession and the public prevail, all the legislation by
the combined wisdom of the medical men of the continent
will fail to sustain. We do not underrate the standard in
saying that under any system of education, whether that

Editorial. 305

which requires but little expense of time and labor for the
attainment of the doctorate, as in this country, or that which
requires a protracted period of probation without reference
to extent of qualification, with frequent and seemingly rigid
examinations, before the honor can be claimed, as in other
countries, the diploma can be but a simple certificate that
its bearer has complied with the requisitions necessary to
its posssession. And another fact should be remembered,
that no odds what the requisitions may be, as to time, evi-
dences of qualifications, &c, the testimonial will, too fre-
quently be placed in the hands of persons, who, if not at the
time of reception, afterwards become unworthy. This as-
sertion is sufficiently attested by a single case reported
some years since, through the pages of the London Lancet.
In England it is well known that an entrance upon the duties
of practitioner of different branches of medicine is guard-
ed by statutory provision, and that considerable time must
be consumed, and a variety of examinations must be endur-
ed, before the applicant can become a licentiate, or attain
the privileges of surgeon, or the dignity of doctor of physic.
Notwithstanding this, there, practioners are, sometimes, so
positively unfitted for the duties of their vocation as to
make the cheek of philanthropists to tinge with very shame.
Such was the character of one who had in charge a case of
labor, and actually pulled two or more yards of intestine,
thinking it was the umbilical cord, from the vagina, into
which a loop of bowel had fallen through a rupture. So
soon as he discovered his mistake, he cut off, and attempted
to conceal the intestine. We are sure that such ignorance
would not be countenanced even here; that such depravity
would with us meet its merited reward. The case is one,
mayhap the worst, illustration of the fact, that the honor
most difficult of attainment, is not always worn by one most
deserving. It is, however, an apt example to be cited by
those who are unwilling that a diploma shall be received
as anything more than a simple certificate that its possessor
has credibly passed through a prescribed period and kind of
study.

306 Editorial.

It will not be gainsayed,we presume, that the practitioner
who has attended four months on lectures, all other circum-
stances being equal, is better qualified to judge of the man-
ifestations of disease and direct the application of remedial
agents, than the one who has assumed the responsibilities
of his vocation without ever having been a matriculate in
a Medical College ; and under the same st^te of circum-
stances, the practitioner who has attended eight months of
lectures, and has undergone the necessary formalities, and
has obtained the degree, is brtter prepared to discharge
safely and faithfully the duties of the physician, and to sus-
tain the dignity and illustrate the importance of the pro-
fession, than the one who was but a "single course" student.
Notwithstanding the manifest truth just noted, there are
many practitioners who have never availed themselves of
the benefit of lectures, and fully as many who were satisfied
with the informatien attained by attendance on one course
of lectures, and who are justly esteemed equally with those
who have received degrees from colleges. These latter
have relied on the diploma giving them importance, whilst
the others laying aside the extraneous influence of college
education, have boldly and nobly pressed forward in self-
reliance, stretching forth their arms and grasping the fa-
cilities which the press and their own personal energies
place before them. And this result, we contend, has not
proceeded from the fact, to use the language of committee
of 1847, "that the large number of colleges throughout the
country, and the facility with which the degree is obtained
have e'xerted a most pernicious influence ;" but we believe
it to proceed directly and inevitably from the false estimate
which has attached to the parchment. Too many, by far,
consider the possession of a diploma as entitling them to
all the honor and consideration which is justly bestowed,
when personal energy and attainments demand ; and with
the attainment of the testimonial their efforts cease, or, at
best, are limited to more referential examinations of works
professedly eminently practical, but, in fact, compiled, that

Editorial. # 307

ease maybe addod to the dignity which has been conferred.
These become, of course to a greater or less extent, accord-
ing to their individual capacities and acquirements at the
time they became M. D's, disqualified, and in accordance
with that extent, dead weights upon the profession. The
influence is evident. Others seeing that the diploma in it-
self gives but little influence, except with the members of
the profession, and with a perception peculiar to those in
the habit, from necessity or temperament, of self-reliance,
discover that practice is obtained through other means, and
permanently sustained mainly by an amount of knowledge,
and ability to use it, relatively equal or superior to their
immediate competitors, are satisfied to use those means what
ever they may be, and are content with just so much
knowledge as will give them, with the extraneous assist-
ances, a show of respectability. True, as we have estima-
ted, and are proud to know is the fact, there are some who
have never seen a Medical College, or have been but four
months attending lectures, who have fought manfully to fit
themselves, that they might conscientiously discharge the
duties of the position they assumed and succeeded; but these
are few, compared with the host, who, without being college
learned, fully justify themselves like their neighbors, the
graduates, by treating diseases according to a rote. These too,
in accordance with the extent of their surreptitious respecta-
bility, ignore the efforts of the true physicians, who always
are even down to green old age, medical students,and prevent
the profession from receiving that respect which otherwise
the result of their indefatigable thought and research would
command. But the influence of a false estimate of the
degree does not stop here. The Faculties of the colleges,
under the specious plea of dignifying the profession, offer in-
ducement to persons to commence practice at a period
when their reading is too limited, to say nothing of personal
observation, to enable them even to make a distinction be-
tween pill and bolus, by offering to confer the degree after
four years practice and four months attendance on lectures.

308 « Editorial.

How many are annually graduated who commenced prac-
( tice six months fledgelings from their preceptor's books, we
leave others to determine. The fact, however, that many
such are diplomated, stands prominently forth as an offset
to the honied words of the committee of 1847.

"We are, moreover, unwilling 10 inflict such discredit upon the ins
genuous youth of the land, as to imagi-ne that they would not voluntarily
become the pupils of that school whose diploma is to be gained by a more
prolonged and complete course of study. They will feel that their success
in after life will mainly depend upon the labors of their earlier years ; and
when success shall crown their efforts, they will enjoy the proud satisfac-
tion of knowing that it is based not upon the disgraceful trickery of the im-
postor, but upon the solid foundation of positive acquirement."

The happy Hooker says: "There is not as much gratitude
in the world as is commonly supposed ;" and his reviewer
adds: "the spirit of the age is hostile to such a feeling as
gratitude." We may alter this language, and beg the com-
mittee and Hooker's reviewer, who we opine will have but
little sympathy with our views, to remember that there is
not as much honesty of purpose in the world as is generally
supposed, and that the spirit of the age is hostile to the cul-
tivation of such a virtue. By far too many af the "ingenu-
ous youth of the land" commence the study of medicine with
an "eye single" to the acquisition of money, without hav-
ing a proper sense or knowledge of the duties, responsibil-
ities, and legitimate aims of those who take upon themselves
the treatment of disease ; and stimulated by the desire of
gold they disingenuously bring everything to bear except
that very important thing — understanding the elements of
that vast field of knowledge with which they profess to be
most familiar. Speed is given to their desire for the prac-
titioner's fee, and the humility of the pupil is soon laid aside,
to give place to the more profitable dignity of the physician,
until the tide of success seems full in their favor, perhaps,
they will use the plea of poverty, and an anxious wish to
rise superior to the circumstances in which fortune has
placed them to awaken sympathy, and excite friends and
relations to their support and to labor earnestly to obtain
them patients ; or, worse still, perhaps, may attach them-

Editorial. 309

selves to some popular denomination of christians, and
thus emphatically "steal the livery of heaven to serve the
devil in." If we have reasoned correctly, the conclusion is
inevitable that until different relations are instituted be-
tween the public and the profession, the "ingenuous youth"
of the land will not seek instruction for the purpose of in-
struction, but if the stands from which it is enuciated be
visited at all, it will be from simple formality. If it be a
fact, that, annually, as many commence practice, without
any course of study, other than a limited office reading, as
are added to the profession by graduation, does it not sus-
tain that committee of 1847, in saying — -"If the require-
ments for license be placed too high, in the existing state of
society in this country, the license will be altogether dis-
pensed with, and persons v/ill engage in practice without
it." And again, the resolutions of the Association were
originally passed in 1847, confirmed in 1848, and reiterated
in 1849, — and notwithstanding the denunciation of the mul-
tiplication of medical schools, the number has very mate-
rially increased, new ones being instituted in states in
which others existed, and Faculties organized with special
charters, or under university privileges in states, which, be-
fore, sent their medical students abroad to acquire wisdom.
Notwithstanding the recommendations of the Association,
that lecture terms be lengthened, the schools have but, to a
very limited extent, complied, and that compliance, with-
out, probab} 7 , a single exception, is more pretended than
real, being merely a gratis course of extra lectures, w 7 hich
the pupil may, or may not, attend, as he elects, and which
is in reality more of an electioneering manoauvre, than an
effort to advance the reform measures suggested by the
professional congress.

Notwithstanding the recommendations intended to sus-
tain the assumed importance of the diploma, the testimonial
is now bestowed with a freedom, if not looseness, which is
most truly amusing to those who, like the writer, have no
regard for it whatever, beyond that which the school boy

310 Editorial,

has for his ticket of merit — he knows that it certifies for
time which has been passed, and deportment which has
been observed, but is no earnest for the future.

We can have no objection to the general proposition
that the degree should be more circumspectly bestowed, —
but we do think that an effort to make it a carte blanch of
worthiness prospectively is wholly out of the question,
promising nothing as an efficient means to produce the ob-
ject which is anticipated. Keep it before the people, that
all is not gold that glitters, and furnish them with the test
aids, by which they may determine the pure, from the alloy-
ed metal, — that which is base will then be easy of detection.
Institute a standard of valuation, which when applied will
cover the unworthy with shame, and bestow honor on the
meritorious, whether or not graduates of medical schools.
The people do not now demand of those proposing as phy-
sicians, a capacity and attainments equal to the emergen-
cies which arise, and the responsibilities which are neces-
sarily assumed, in the practice of medicine. If they did,
practitioners would be unsuccessful, who descend from the
high position of the professional platform, and solicit pa-
tronage, as the political demagogue solicits votes, — nor
would the people turn from physicians who have labored
many long, wearying hours, qualifying themselves to fight
with confidence and skill against disease — from these the
people would not turn to place their reliance on secret
compounds. But if a criterion be determined upon, if the
efforts of physicians to reform be more popularised, the true
medical philosopher will be a more ordinary personage, and
a sucessful empiric, systematist, ignoramus, or quack will
be an actual phenomenon.

These have been our views — and every succeeding day
gives us new occasion to be strong in the conviction that
they are correct. And, though we have always felt that
the plan of the Association would fail in bringing about any
change, we have in our sphere, and to the full extent of our
limited ability, zealously labored to sustain the resolutions

Editorial. 811

and recommendations of that most august body ; — and we
feel bound by every sense of honor, not to do any thing con-
trary to the resolutions and recommendations, so long as
they remain active, as expressing the opinion of the wisest
of American doctors. But, nevertheless, we are anxious,
because we feel that we occupy the correct ground, for our
views to be analysed and tested, and if found to be errone-
ous, we will confess ourself incapable as an observer, ten-
der our resignation to the honorable Association, vacate
our position, humble as it is, in the profession, leave it as
a gem encased in impenetrable dross, and find lor ourself
another vocation amongst men. But until our views are
subjected to a fair test, we will continue to press them, if
necessary, even until the years draw nigh when we shall

say we have no pleasure in them, for

My desires
Run not before mine honor, nor my wishes
Burn hotter than my faith.

Kentucky Medical Society.

From a private letter, written by an influential member
of the Kentucky Medical Society, we learn that the second
meeting of that Society was held on the 20th of October
last, — about one hundred and twenty or thirty members
being present. How does this contrast with the number in
attendence on the Medical Society, of the state of Tennes-
see, during the last session — one hundred and thirty and sev-
enteen ? Truly, have we of the profession, in Tennessee,
fallen upon evil times,when but seventeen of us can be found
in the profession of sufficient esprit de corps to give a few
hours of time, and a few dollars of money, towards the sus-
tenance of a state professional organisation. Praise and
commendation from those who sustain such societies in oth-
er states, is due to those seventeen Tennessee physicians,
who so nobly came forward last May, and placed them-
selves as supporting columns to the crumbling ruins of the
State Medical Society ; indeed, the columns are more im-

312 Editorial.

pressive, more stately in their relations to the profession, as
a whole, than the building which they have prevented
from being numbered with the "things which were, but are
not." And if some plan, through which the practitioners of
the whole state will be associated with them, can be devis-
ed and carried out, by the seventeen, their names will de-
serve to be placed on an illuminated page of the record of
the profession, their "virtues engraved on brass, and their
vices written in water."

The proceedings of the Kentucky Society w r ill be pub-
lished, and will make a volume of some three or four hun-
dred pages, containing some very creditable reports.

We can not give full expression to our feelings of pleas-
ure and of thanks, that of the three distinguished medical
men of the country, who were deemed by the one hundred
and thirty medical men of Kentucky, as entitled to special
regard, one was a Tennesseean — native born, and home-
bred — Dr. Wm. H. Deaderiek, of Athens.

Our friend writes: "In conformity with a provision of
our constitution, we elected three honorary members, Drs.
Deaderiek, of Tennessee, Drake, of Cincinnati, and Bartlet,
of New York. It affords me much pleasure that Dr. Deade-
riek is among the first to receive this honor at the hands of
our Society. I prize highly the labors of our pioneer.
Long may he live to receive other and more honorable tes-
timonials of his profession."

Who 'originated the idea of a National Medical Congress ?
We are unable to answer the question, notwithstanding
we have heard, at a festive board, a toast proposed to the
gentleman, which was responded to, by a member of the
profession, who considered the sentiment applicable to him-
self. We think the idea is one of sufficient importance to
have its paternity established, and, therefore, transcribe the
following remarks, which were made as long ago as 1831,
by Professor Caldwell, then resident in Lexington, Ky.; if

Editorial. 313

the idea was previously expressed by any one, we have yet

to discover the place of its record.

"The physicians of the United States have it in their
power to form the most magnificent and useful institution
in medicine the world has witnessed. It may be made to
embrace the whole union, and to confer on the profession,
and on mankind, incalculable benefits. Nor is there any
difficulty in the enterprise, provided it be attempted with
unanimity, vigor and resolution, and under the lights that
may be easily brought to bear on it. It consists in the
formation of a Medical Societv in each state, under the au-
thority of a law of the state, and composed of all the edu-
cated and respectable physicians that reside within its lim-
its. * # * Let these Societies be connected by a Diet,
or Amphyctyonic council, composed of a deputation of mem-
bers from each, to meet as often as may be deemed requi-
site, and superintend the interests of the whole. # # *
Under a wise arrangement and a skillful and vigorous ex-
ecution, a blaze of medical light would ultimately issue
from them, such as time has never witnessed. This light
would arise from various sources, and be diffused in various
ways. American medical literature, in general, would be
gr itly promoted by the arrangement proposed. Am I
asked, in what way? I answer, that by their frequent
meetings, the Societies would render both reading and
writing more fashionable, than they are at present. From
certain well known principles which govern human actions,
as well as from the result of all experience, in such cases,
this effect could not fail to be produced. American period-
icals in medicine would circulate much more extensively,
and be better supplied with original and useful matter. #
* # One part of the duty of the Diet, or General Coun-
cil of the Societies would be, to propose Prize Questions, on
suitable subjects : such a measure would be necessarily pro-
ductive of many valuable essays. # * # j n fine, by
thus federalizing a scheme for the promotion of medi-
cine in the United States, the medical statistics of our
country might be developed to an unprecedented extent, and
the profession placed on an eminence it has never before
attained."

314 Editorial.

We hope that the distinguished editor of the Examiner
will excuse us for the unintentional error which our last
number contained — placing him in association, different
from that to which he was called, and which he chose to
accept as teacher. It is proper that the benefit to be deriv-
ed from the influence of his name and talents should be en-
joyed by the Faculty of which he is a member. Our no-
tice should have congratulated the Faculty of the Pennsyl-
vania Medical College, upon the accession of Dr. F. G.
Smith, to the chair of Institutes of Medicine.

Tfie editor's tabular report of cases, occurring during the
year 1852, will be concluded in the next number of the Re-
cord. Several circumstances have occurred to prevent the
compilation, in season for this number.

Webster's Post-Mortem.

It has been already stated that the post-mortem exami-
nation of Mr. Webster was made a day or two after his
death. The Boston Courier says :

We understand that at a recent meeting of a medical so-
ciety some of the more striking results of the examination
were stated, and formed the subject of an interesting scien-
tific discussion. The cerebral organs were of the very
largest known capacity, exceeding by thirty per centum the
average weight of the human brain ; and,with only two ex-
ceptions, (Cuvier and Dupuytren,) the largest of which
there is any record. It is also worthy of remark that a
well marked effusion upon the Arachnoid membrane was
discovered in these investigations, although there were no
perceptible evidences of any lesion during Mr. Webster's
lifetime. It is supposed to have been caused by his severe
fall from his carriage in Kingston last spring. It is a re-
markable physiological fact that an injury which would
have impaired the intellect, if not at once caused death, in
another, should in this instance have been attended with so
little external evidence of so important an injury to a vital
organ.

The above we find going the rounds of the newspapers.

We do not know why his medical attendants have never

Editorial. 215

given a professional report. We have looked anxiously at
every no. of the Boston Med. Jour, for it; but have so far fail-
ed to find any thing of the kind, and we presume if one
had been made, of course, it would be published by author-
ity, in the medical journal belonging to the state of the dis-
tinguished statesman. The report, which is given above,
can not be correct, as published, or the medical man from
whom it emanates is destitute of familiarity with the most
approved writers on pathology, or they are all wrong. Ef.
fusion, in a greater or less degree, is to be expected in the
aged.

To the Medical Profession of Tennessee.

The Tennessee Medical Society, at its regular annual
meeting, held in Murfreesboro', on the 5th of May last, ap-
pointed the undersigned a committee to investigate, and re-
port (to its next regular meeting, to be holden in Nashville,
on the first Wednesday in April next,) upon "The History of
Epidemic Diseases of Tennessee."

To meet the expectations of the Society, in the discharge
of this duty, the committee, of course, will be obliged to
look to their professional brethren throughout the state for
the materials of their work.

It is true the committee intend soliciting medical gentle-
men, personally, in different parts of the state, to interest
themselves in behalf of the undertaking ; yet, there are hun-
dreds, no doubt, both in and out of the state, who are in
possession of facts of great interest and value ; but being
unknown to the committee, they can not be personally ad-
dressed. To all such gentlemen, most earnest entreaty is
now made for their co-operation.

In tracing out the histories of epidemics, it is desired that
reference be had to the following points of general interest,
viz : The particular date of each epidemic visitation ; the
extent of its prevalence ; the proportion of the population
attacked i the proportion of the attacked that died ; the
classes — male or female, white or black, young or old —

216 Editorial.

which most suffered ; the length of time the epidemic pre-
vailed ; the cause or causes which seemed to have deter-
mined its invasion, spread and decline ; the characteristic
symptoms ; the pathological discoveries from post mortem
examination ; the general treatment (curative and prophy-
lactic) pursued; the medical topography of the infected dis-
trict ; the sanitory condition of the district at the time of the
epidemic prevalence ; the state of the weather, &c, &c.

It is also desired that reference be had to the following
points of special interest, viz : Of Fevers — whether or not
the endemic — [endemic diseases become, often, ejndemic]
— Fevers have changed their character, or type, since
their first appearance in the locality, and, if so, at what
time, and in what way ; whether they are on the in-
crease, or decrease ; whether they are more or less fa-
tal than formerly ; the ostensible cause, or causes, of
those changes ; when was Typhoid Fever first recognised
as distinct from the miasmatic Fevers of your country, and
upon what grounds (symptomologicHl or pathological) has
it been given that name : Of Dysentery — whether or not
it is an annual visitant of the country, and, if so, at what
season of the year; whether it be on the increase or de-
crease, and whether it be more or less obstinate than for-
merly : Of Cholera — a minute account of all well authenti-
cated instances of its apparent production, by contagion :
Of Scarlatina — the frequency of Dropsy and chronic Kid-
ney affections supervening on this Fever.

In aSmuch as the American Medical Association had al-
ready appointed a committee to investigate the epidemics
of Kentucky and Tennessee, it may at first sight ap-
pear that the Tennessee Medical Society, in appointing the
committee, who now address you, has undertaken to do that
which is already being done.

It may not be amiss, therefore, to correct any such impres-
sion, as well as show the exact harmony of the two com-
mittees.

The committee of the American Medical Association take

Editorial 21?

no cognizance of past epidemics — i. e., those occurring prior
to the appointment of the committee — whilst this is the le-
gitimate duty of the State Society — the researches of the
former are prospective, whilst those of the latter are perspec-
tive — the labors of the one commence, where those of the
other cease. [Read the address of the committee of the
Amer. Med. Association, puplished in the Aug. number of
the Nashville Jour, of Med. and Surg.] The Tennessee
Medical Society acted under a sense of the importance to
western medicine, of the due performance of the labors un-
dertaken by the committee of the American Association,
and it was to perfect the History of Epidemic Diseases, so
far as Tennessee is concerned, that the committee, below,
were appointed. And now it is confidently believed that
every one will willingly aid in both labors, seeing that they
are intimately and harmoniously related.

Information with regard to published documents or papers
upon epidemics in Tennessee ; or upon the medical topo-
graphy of any part of the state, is earnestly solicited.

C E. B. Haskins, M. D., Clarksville.
Committee. < A. H. Buchanan, M. I)., Nashville.

( J. J. Abernathy, M. D., Murfreesboro'.

Clarksville, Tenn., August, 1852.

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OBITUARIES.

We can not record the mournful intelligence in more appropriate lan-
guage than that used by the editor of the Nashville Medical Journal, that

"Daniel Drake is no more. We learn by telegraph that
he died at Cincinnati on the 5th Nov. Thus has fallen a
truly great and learned man — one who centuries from now
will be classed with Hippocrates and Sydenham. Ameri-
can medicine has lost the chief pillar of its glory, and the
light which made gorgeous her temple is extinguished for-

ever."

Died, recently, at Lancaster, Dr. Sam'l Humes, an old and
much estemed practitioner of Pennsylvania.

It is to be hoped that some one familiar with his person-
al history will furnish to the medical press, a biographical
notice of this aged and worthy man.

THE EAST TENNESSEE

RECORD OF MEDICINE AND SURGERY.

MAY, 1853.— No. 4.

ORIGINAL COMMUNICATIONS.

Art. I. — A Short Essay on Milk Sickness, (Colica Tremen-

tia,) presented to the East Tennessee Medical Society, by

Dr. John T. Jones.

Mv object in presenting a few observations on "Milk
Sickness," is more with a view to elicit inquiry and incite
a spirit of investigation, among the the members of the
Society, into the cause, and the treatment most likely to be
successful in this formidable disease, than a hope that I shall
be able to elucidate its true character, or bring to light its
most probable cause.

Many of the finest portions of East Tennessee are known
to produce this loathsome disease ; many of her most
enterprising inhabitants have fallen victims to it. And
it is well known, that it has long been quite a fruitful
source of tedious and expensive litigation, from the fact
that many have been interested in lands where the
disease has been, and is yet thought to originate. Hence
the necessity of scientific investigation and research, and
even should we not succeed in discovering its real cause ;
may we not hope to approach nearer to its true character,
and consequently derive much valuable knowledge relative
to its extent in our country, and the most successful mode of
preventing and treating it ?

322 Dr. Jones on Milk Sickness.

In presenting the following observations on Milk Sick-
ness, to this Medical Society, I do not flatter myself that I
shall be able to present many new and important facts
relative to this subject. I only hope that I may succeed in
establishing a few observations, that, perhaps, have not been
familiar to, at least, the junior members of this Society.

I have been led from observation to attribute this disease
to a mineral poison, from the fact that it is generally met
with in the vicinity of mines, and from the fact, also, that
it is confined to particular localities, more or less limited.

But the strongest evidence to my mind, and the one best
calculated to sustain my position, is the following, viz :
That the poison producing "Milk Sickness" exhibits charac-
teristic phenomena on the animal economy peculiar to
mineral poisons. We know that vegetable poisons exhaust
themselves by acting ; when they have produced their
effects and run through their course, or different stages, they
never again show themselves. There are, it is true, some
apparent exceptions. Digitalis purpurea is, by some,
presented as such. It is true, says Dr. McAnelly, "that
you may give it for a few days, without obtaining its effects,
and then it may show itself in a very alarming manner — ex-
hibiting all its characteristic phenomena ; but once let its
effects pass, the patient yet alive, and they do not again
show themselves."

All narcotics have a double operation, or two stages dif-
fering materially from each other, the first, stimulating ; the
second, sedative ; but let them once pass through their dif-
ferent degrees and they are done, and will not go back and
run the same course over again ; and so with all other
known vegetable poisons. But this is not true of the min-
eral poisons — they will produce their effect, then apparently
disappear, but remain dormant in the system for months,
perhaps years, and then show themselves when aroused by
some exciting cause, running the same, or a similar course,

Dr. Jones on Milk Sickness. 323

producing all their characteristic effects. This is a fact
too well known to be disputed.

This I conceive to be one of the strongest proofs that the
disease in question is not produced by a vegetable, as some
have contended, but by a mineral poison. For a patient
may contract the complaint — be relieved — remove from the
infected district, to a place where the disease was never
known before — remain for a time apparently well — when it
will again show itself, probably with redoubled violence
and energy, running the same course, and hurrying its vic-
tim into an untimely grave. In corroboration of the above
assertion, 1 will state a circumstance that occurred under
my own observations. A Mr. Taylor and his family, who
had contracted the disease in a "milk-sick" district in the
mountains of North Carolina, and who had been relieved
afterwards, settled in the neighborhood where I was born,
(Southwestern Virginia,) where "Milk Sickness" was never
known to prevail for many miles around. They remained
in the neighborhood and appeared to enjoy excellent health
for about two years. In the autumn of the second year, the
father, mother and two brothers were again seized with
symptom of "Milk Sickness ;" the disease assumed a vio-
lent character ; physicians were called, and the common
course of treatment resorted to, but without producing any
beneficial effects. The husband and father of the family,
fifteen minutes from the first symptom of attack, sank
beneath the fatal stroke of this distressing and loathsome
disease ; then the oldest son ; next the brother, and finally
the mother. Not another case occurred in the whole
country either of man or beast. Could a vegetable poison
lie dormant in the system for quite two years and then break
forth with such virulence, destroying life in a few hours ?
Is there a single case in the annals of medical history of
the kind ?

I am aware that many physicians, some of them eminent
in their profession, have been disposed to refer the cause of

324 Dr. Jones on Milk Sickness.

Milk Sickness to some unknown vegetable ; many more
(though not quite so eminent) have pretended to know, and
point out the particular vegetable, but their specimens have
been as various and diversified as the individuals that pre-
sented them. In all cases, where the cause of a disease is
not understood, there will, most likely, be many assigned.
Most of the plants presented to chemists and medical
societies for analysis and examination, and believed by their
discoverers to possess the cause of Milk Sickness, have
been found to be common to every part of the United
States ; whilst the disease itself is known to be confined to
limited localities.

Dr. McAnelly speaks of a gentleman residing in the
neighborhood of Columbus, Ohio, who was sanguine in the
belief, that he had discovered the plant, the source of all
the evil; and left a specimen, which upon examination
proved to be the Rhus Toxicodendron, a plant well known,
and found growing in every part of the United States. The
Lobelia inflata is also said by some to be the cause; it is
liable to the same objections, for it also grows in all parts
of the Union, or, at least, in rich profusion, in many parts
where the disease is not known. It is also evident that the
plants are not capable of producing such effects. Many
others have been brought forward with as little plausibility
as those just mentioned. But it is still urged, by some, that
it is some unknown vegetable, and it is alledged as a reason
that, in districts where the disease prevails, if the land is
put under fence, and the stock kept up, they do not con-
tract the disease, but if permitted to get out but for a short
time, they are frequently attacked by it. Now this is all
very true, but what does it evidence in favor of a vegeta-
ble cause? "I have known," says Dr. McFarlane, "farmers
who have prevented their stock from being destroyed by
this precaution, yet I can not see, (he continues,) that this
proves any thing about the cause, except that it was not in
the pasture."

Dr. Jones on Milk Sickness. 325

"Yet," continues Dr. McFarlane, "it does also prove that
the cause of the disease was circumscribed, as a lick, a
spring or a mine. Certainly it does not prove that it is a
vegetable, for persons frequently, settling on a new place,
fence the woods, put up their stock, and prevent the disease.
Now it is plain that running the fence, does not destroy the
vegetables, yet the disease is prevented. Besides the dis-
ease sometimes prevails on old farms, when the stock is kept
up, which does not prevent them from taking it."

To substantiate this opinion or statement of Dr. McFar-
lane, I will introduce the testimony of Dr. McAnelly, of
Kentucky; he says: "I am well acquainted with an old
farm, owned by Mr. Williams, within half a mile of Johns-
town, Ohio. This farm contains about two hundred acres,
mostly cleared, and all under fence ; the undergrowth of
of the woodland is all cut or grubbed out ; it is bounded on
one side by the village, on the other three by improved
farms ; his stock are kept up ; his house stands on a com-
manding hill about tw r o hundred feet above the level of a
small brook that meanders at the foot of it ; they use the
water from a well that goes dry in extremely dry seasons,
which, when it becomes low, is not good, and they are
compelled to haul it from a distance. Mr. W. and wife
were attacked every summer. I was called to see them in
August, 1833, in their fourth attack, and 1 do not recollect
(says the Doctor) ever having seen a more violent one.
One or more families had previously resided at this place,
all of which had suffered more or less with the disease.
This, in my opinion, (he continnes) is pretty strong proof
that it is not produced by a vegetable ; at least, it shows
that keeping up the stock, will not prevent, it under all cir-
cumstances. The general opinion there is, that it is
produced by the water in that well. The village stands on
the same hill with the farm, and is also watered by wells ;
the inhabitants have likewise suffered much from the dis-
ease — the drier the season the more it prevails. Other

320 Dr. Jones on Milk Sickness.

animals do not suffer so much here, as in other places. I
do not recollect seeing or hearing of a single animal being
affected with it, while I was in the neighborhood, though, I
was told, they sometimes die with it."

It was long the opinion of the early settlers of East
Tennessee and West Virginia, as I have been informed, that
the disease was produced by poisonous exhalations from
mineral substances in certain places ; and that it fell with
the condensed vapor during the night, upon the herbage in
its immediate neighborhood ; or, in other words, that it was
combined or intimately mixed with the dew, and, in this
form imbibed by their stock, feeding upon the plants before
the dew was dissipated by the morning sun.

The foregoing opinion of the early settlers, I conceive to
be quite a plausible one ; and, I doubt not that this idea
originated from observations of a more convincing charac-
ter, and better calculated to lead to the true cause, than
many of a more modern date. The pioneers of Tennessee
were under the necessity of herding their stock by day and
keeping them in folds or enclosures at night, in order to
avoid and counteract the theiving propensities of their red
neighbors. They were, therefore, better acquainted with
the habits of their cattle, and watched more narrowly the
cause and progress of disease among their herds, than we
do at the present day — they being their only wealth they
were induced to take more care and to examine more
minutely into the cause and character of their diseases.
They did not attribute the source of the disease to a vege-
table, because it was reasonable to infer that their cattle
would not be likely to feed upon a poisonous plant, when
luxuriant herbage, such as cane and pea-vine, grew in rich
profusion on every plain. But, at a later period, the very
arguments used by them to disprove the possibility of the
cause of Milk Sickness being produced by a vegetable,
have been weilded against them, in order to prove the fal-
lacy of their opinions, alledging that the arguments used by

Dr. Jones on Milk Sickness. 327

the old settlers are well calculated to establish the opinions
of those entertaining the belief, that it is caused by a vege-
table, and here 1 will present an instance : Says one
of the advocates for a vegetable cause : "In the first
settlement of the Goose Creek neighborhood, in Tennessee,
this sickness was unknown; owing, I believe, to the vast
profusion of the pea-vine, &c, stock could get their food
without much trouble, and consequently did not eat the
poisonous plant ; but, as the country became older, the
range became less inviting and the stock, naturally anxious
for herbage, would, it is likely, feed upon noxious plants ;
and hence, we may reasonably account for the prevalence
of Milk Sickness in our vicinity."

This, at first sight, may look reasonable, but when we
reflect that the land in many places, where the disease pre-
vails, is very rich and vegetation still grows very luxuriantly,
most particularly at that season of the year when the sick-
ness is most prevalent, we should think that if there was
any thing in the supposed plant that would cause the cattle
to shun it in early times, they would not be compelled to eat
it now. It- appears, therefore, that we should look to some
other source for the cause. Would it not be more reasona-
ble and philosophical to examine the geological changes
that have taken place and see if there can not be a reason
found in this quarter.

"We know," says Dr. McAnelly, "that the minerals lie
beneath the soil, and as the country becomes settled and cul-
tivated the washing of the soil lays bare the different kinds
of minerals and stones. The gold in Virginia, North Car-
olina, &c, (continues the Doctor) was not found until the
country became old and the beating rains exposed it to view
— I presume that no one could say, that the gold was not
there when the country was new. There are (he continues)
instances on record, where poisons have been exposed in
this way, and animals destroyed. Mr. Parks mentions, that
he visited a mine of Carbonate of Barytes, at Anglezark,

328 Dr. Jones on Milk Sickness.

in the county of Lancaster, England, and was informed by
Mr. Derbyshire, who occupies the estate on which the mine
is situated, that some years since he lost three cows at one
time, which had strayed from their pasture and were found
licking some lumps of the spar, which, at that time, lay
about the mouth of the mine in abundance. He also stated
that it was impossible to keep any fowls on the estate, as
they mistook the barytes for white sand, and were sure to
die the first day they were brought on the place."

I have not introduced the above statements of Dr. McA-
nelly to prove that the Carbonate of Barytes is the cause of
Milk Sickness; by no means, yet it may be ; but my main
object in quoting his remarks, was only to show the proba-
ble cause of its not showing or manifesting itself in the
early settlement of a country. We know that in many
places where, twenty years ago, not a stone could be seen,
the ground is now covered with stones, fossils and mineral
ores ; may not the poison causing this disease after a lapse
of years become exposed in the same manner, subjecting
man and beast to this disease, where it had not been known
before ?

It has also been observed by the advocates of this opin-
ion, viz : that it is produced by a vegetable ; that the dis-
ease never originates in any but herbivorous animals, and
from them communicated to the carnivorous and amnivo-
rous, by eating their meat, milk, butter, &c. This 1 am of
opinion is a mistake. Dr. Shelton, if I do not forget, in an
inaugural dissertation, submitted to the examination of the
President, the trustees and the medical professors, of Tran-
sylvania University, &c, speaks of dogs contracting the
disease from the water of certain milk-sick districts in
Indiana. The dogs had been kept up or chained to prevent
them from feeding on the carcasses of beasts dying from
the effects of Milk Sickness — they were fed on bread and
water alone— but to no purpose— they seemed as liable as
those running at large. Dr. McAnelly denies, positively,

Dr. Jones on Milk Sickness. 829

the statement, that it never originates in any but herbivo-
rous animals. "This," he says "is entirely gratuitous and
really (with all due deference to higher authority) is not
the fact. I have now (says the Doctor) before me a com-
munication from a highly respectable physician of Tennes-
see, who informs me that he has resided all his life in a
section of the country where this disease prevails, and that
many individuals, from the fear of taking it, have abstained
from meat, milk and in short everything except a vegetable
regimen, yet many, under the circumstances have taken it
and died."

I will now present another opinion entertained by some
on this subject, viz : That it is caused by some unknown
mineral or saline substance held in solution by the water,
or mixed with the soil. The arguments in favor of this
opinion are,

First, That its bounds in each locality are evidently small.

Secondly, The disease sometimes prevails in the human
species in districts where the inferior animals are compara-
tively exempt, and, frequently, where none of them are
known to be affected at the time, as in the neighborhood of
Johnston, Ohio, previously spoken of by Dr. McAnelly,
where the inhabitants contracted the disease from using the
well water in the dry fall seasons. "In this place," says
the Doctor, "it is different from most others I am acquainted
with, being worse in the latter part of the summer and the
beginning of autumn, w T hen the water in the wells is lowest
and the poison (if contained in them) is consequently more
concentrated.

Thirdly, That it occurs in winter, when vegetation id gen-
erally slumbering and stripped of its foliage.

Fourthly, Individuals have been known to take the dis-
ease that did not eat meat, milk, or any thing of the kind,
but lived on a simple vegetable diet. Now this appears
pretty conclusive that they must either have inhaled, ab-
sorbed, or drank it ; and as the latter is the most plausible

330 Dr. Jones on Milk Sickness.

to us and corresponds more nearly with the observations
on the subject, we conclude that this is the way in which it
reaches the system. In further confirmation of this view
of the subject, permit me to introduce the statements of Dr.
White, of Indiana. He says : "I was informed by a re-
spectable farmer, that his cattle had been in the habit of
frequenting a pasture ground in company with his neighbor's
on the opposite side of a creek from him ; in returning home
his cattle were obliged to cross the creek ; for many years
not a case of the disease appeared among them, while his
neighbors lost some forty or fifty head during that time.
The animals of the latter did not cross the creek, but drank
at another stream. Both herds ranged the same woods,
and fed upon the same herbage." It is presumed, therefore,
that the disorder was produced by the water ; and in con-
firmation of this opinion, this individual further stated to
me, "that, suspecting a spring, at which the cattle drank to
be the origin of the evil, he set to work felling trees around
it, so as to exclude his stock from it, and that afterwards they
suffered no more with the disease for several years ; at
length, however, it recurred again, and on examination it
was found that the spring had become accessible from the
decay of the timber. The enclosure was repaired and the
cattle shut out from the water — the disease a second time
disappeared."

"Another respectable farmer," says the Doctor, "told me
that a number of his sheep, kept upon a grass lot on ac-
count of the wolves, had died with the symptoms of Milk
Sickness. During every season several had died for a
series' of years, until his flock was nearly destroyed. He at
last began to suspect a dripping spring in the lot as the
source of the mischief, and accordingly took measures to
secure the animals against it, whereupon the disease ceased.
In this lot it is not probable that there existed any vegeta-
ble to which the affection could be attributed." This it
seems to me, is sufficient evidence to establish the opinion

Dr. Jones on Milk Sickness. 831

that the cause sometimes, or in some instances, belongs
to the water of certain springs, or, that it is held in solution
by the water of some drains and fountains. But, before I
close this part of my subject I will introduce further evi-
dence more immediately in our neighborhood. In Blount
county, Tennessee," says Dr. Shelton, "there is a locality
embracing not more than ten or fifteen acres on which the
disease has been known to originate for nearly, perhaps
quite, forty years, I was informed by the proprietor of the
land, that, by watching his cattle for a few years, he was
enabled to discover the limits of the poison ; and that by
enclosing the infected region in a fence, so as to exclude his
stock from it, the disease ceased to be troublesome, except
when an animal got by accident into the enclosure." An-
other locality spoken of by Dr. Shelton, may be found in the
county of Monroe, in this State, about the size of the first,
in which the disease, previously very annoying, was sup-
pressed for eight or nine years, by enclosing the seat of the
poison. But during the last few years, he says, the enclos-
ure has fallen down^from decay, so as to admit the ingress
of cattle, and the disease has again shown itself and rarely
fails to occur in animals that feed long on the spot. A third
site is spoken of by Dr. Shelton, on the Chattahooche river,
in Georgia. It is an elevated piece of bottom land, contain-
ing scarcely five acres, shut in by the river and by bluffs on
every side. This spot was easily discovered to be the source
of the disease and was accordingly fenced in securely by
the owner and the evil thus effectually removed.

Lam acquainted with a "milk-sick" locality situated near
the Middle Fork of the Holston river in the county of
Washington, State of Virginia. I believe the disease first
appeared there about fifteen years ago, though I am not
certain that I am correct as to the time of its appearance.
It continued to prevail to a greater or less extent every
autumn, until the inhabitants, suspecting a large marsh to
be the scource of the disease, enclosed it by a strong fence,

332 Dr. Jones en Milk Sickness.

since which time the animals in the neighborhood have
ceased to contract the disease. I have been credibly in-
formed that before the marsh was enclosed as many as
thirty bead sf cattle have died from Milk Sickness, in the
immediate vicinity, in the short space of twelve hours.
The inhabitants in this neighborhood attribute the cause of
the disease to a vegetable, notwithstanding their cattle feed
immediately outside of the enclosure and drink from a
brook that runs through one portion of it, at points both
above and below the enclosure, without ever contracting
the disease. The same kind of herbage that appears in the
enclosure, is found growing outside of it. The water of
the brook passing through it is used by the inhabitants —
their stock drink it — and yet all remain free from the dis-
ease, consequently the cause can not reasonably be attribu-
ted to either the vegetables or the water. The cause must,
therefore, in this instance, be sought for elsewhere. Per-
haps it exists in the soil of the marsh and sends forth (at
certain seasons of the year when miasmata and other
mephistic effluvia are most prevalent,) its peculiar exhala-
tions, which, coming in contact with watery vapor, may
commingle with and be carried down upon the herbage
with its condensed particles as previously noticed in this
article; for it has been asserted that cattle may feed in
the enclosure without the least danger of contracting the
disease after the dew has disappeared from the vegetables.
How far this statement is correct I will not pretend to say.
Dr, Shelton, in his dissertation, designates a great many
localities subject to Milk Sickness some of which I shall
name ; but first, he remarks, "that this disease is most gen-
erally met with in the vicinity of mines." In Tennessee it
prevails in the neighborhood of iron ore which is mixed
with a variety of metals*, the same remark is said to be
true of Alabama, Georgia and Kentucky. In Illinois it is
said to prevail in the neighborhood of the coal mines ; in
Jefferson county, in Missouri, near the minor Breton lead

Br. Jones on Milk Sickness. 333

mines the complaint is common. It also prevails in the
mountainous districts of Western Virginia — a region known
to abound in minerals. In Indiana between the Wabash
and Ohio rivers, this malady reigns over a large district of
country, and it is attributed by the citizens to the use of
water rendered poisonous by metalic impregnations. From
all the evidence that I can collect on this subject, my opin-
ion has become more confirmed that Milk Sickness is caused
by a mineral poison, how far I am correct must be left to
future investigation. If this poison is indeed held in solu-
tion by the water in certain springs, as has been believed
may we not hope to discover it and satisfactorily test it, and
by a careful analysis divest it of all its mystery and subtlety.
I hope the time is not far distant when medical men will
take deeper interest in the investigation of a disease so se-
riously endangering the lives and affecting the interests of
many of our most worthy citizens.

This disease, as before stated, has not occurred generally,
but has seemed to be confined to particular localities, more
or less limited. It frequently happens that the inhabitants
of a single farm will be oubject to its attacks, while the sur-
rounding neighborhood remains entirely exempt. A farm,
situated in the county of Bledsoe, and now used, if I mistake
not, by Col. J. M. Anderson, has long been thought to possess
the source of Milk Sickness, though the particular locality
on it, where the evil is thought to originate, has not been
designated, to my knowledge.

Still, it is said that the disease has prevailed on it, and that
several of the inhabitants, as well as a considerable number
of cattle, have died from the effects of Milk Sickness con-
tracted on it. The surrounding inhabitants, I have been
informed, continued healthy.

Another instance of an isolated cause appears in the south-
east portion of this county.

Two farms, one of them owned by a Mr. McDaniel, the
other by a Mr. Innman, have both been suspected, the farms

334 Dr. Jones on Milk Sickness.

join — the immediate locality of the cause has not yet been
discovered. The stock belonging to each farm have suffer-
ed equally — a great many cattle have died on both. ' The
proprietor of the first named farm, (Mr. McDaniel,) has
suffered considerably ; several cases having occurred in his
family, some of which I have learned from Dr. Butler,
whose experience and acquaintance with this disease entitle
his opinions to the highest respect, were quite aggravated.
All the inhabitants in the neighborhood have enjoyed good
health. But before closing my remarks on the causes of
Milk Sickness, I will just state, that be the cause what it
may, whether vegetable or metalic, it is my opinion that it
is more diffused than many have supposed, and particularly
in the north-west portion of the United States. Indeed, some
of the fairest portions of the west, in consequence of the
prevalence of this loathsome disease, must ever remain an
uninhabitable waste, unless the cause and remedy can be
discovered.

PREVENTIVES.

From the very limited knowledge we at present possess of
the cause and character of this disease, it can not be ex-
pected that certain and efficient means have been discover-
ed for its prevention. Indeed, so far from it that it is a
question in my mind, whether any thing has yet been dis-
covered, calculated to obviate it to any great extent- En-
closing the particular localities where it is known to exist,
has, as before remarked in this article, been known to obvi-
ate ox entirely prevent it in cattle ; yet man has been known
to contract the disease in a milk sick region, where the
inferior animals were entirely exempt. Though I am of
opinion that this is not a very frequent occurrence, I am
disposed to believe that in most instances, the disease is
communicated to human beings by using the milk or flesh
of animals affected by it.

It is said that clover in a green state, will prevent the
disease in cattle feeding freely upon it. Other nutritious

Dr. Jones on Milk Sickness. 335

succulent vegetables may act in a similar manner; but their
efficacy is not so well established.

The beneficial effects of clover are shown by sowing it in
ground known to have afforded the milk sick poison, in
which case the disease ceases to appear, especially in cows
yielding milk. This experiment I have been told has been
repeatedly performed in Tennessee and Indiana, and has
generally been attended with success. Fields known to
have contained the cause of disorder, have been freed from
it in repeated cases by setting them well in clover, and it
has again appeared on the clover being ploughed up and the
fields sown in grain. Thus the plant would appear to pos-
sess the power in some way, of correcting the poison of
Milk Sickness.

THE ORGANS MOSTLY AFFECTED IN MILK SICKNESS — Colicd tre-

mentia, — symptoms of the disease, &c.

Of the true cause, we are willing to confess our ignorance;
but whatever it may be, the stomach and duodenum appear
to be the arena, of its action. The liver, in many instances,
refuses to furnish its accustomed secretion, and the sympa-
thetic nerves are materially deranged. Dr. White speaks
of the case of a woman who had labored under the disease
for about twelve hours. She was found to be quite insen-
sible to all external objects. This, says the Dr., has been
the only case in my practice in which the brain has been
observed to suffer.

It seems that the poison causing "milk sick" produces
death by becoming absorbed and taken into the blood, and
not by some caustic qualities which it may possess, as some
have supposed. It speedily destroys the vital powers of the
heart, lungs, and nervous system, owing in my opinion, to
its very rapid distribution by the circulation.

An animal affected with the disease is suddenly seized
with rigors, and the whole frame becomes suddenly agitat-
ed. They lose the use of their limbs, and lie helpless in this
state of universal tremor until they expire.

336 Dr. Jones on Milk Sickness.

It is from this symptom, so apparent, that the disease has
been called by the western people, the "trembles? Although
the brain does not appear to suffer in a great degree, yet a
swimming or a dizziness in the head is most generally pres-
ent. A burning heat in the stomach, not unlike that pro-
duced by arsenic or corrossive sublimate, is in most cases
present; unquenchable thirst, retching, and in some cases,
excessive vomiting, are most generally attendant symptoms.
In short, the symptoms are very similar to those produced
by arsenic. If ihe poison has remained dormant in the sys-
tem for a considerable time, and has been aroused by some
exciting cause, say over heat or exposure of any kind, the
disease will be more slowly developing, and the symptoms
less marked in the incipient stage, than in cases originating
from the recently imbibed poison. The vomiting less severe,
the burning heat and fever less distressing, and the rigors
not so alarming, &c. But if the disease be not speedily ar-
rested, it soon assumes all its wonted malignancy, rapidly
hurrying its victim to the tomb. There is always a symp-
tom present in this disease, it matters not how discrepant
others may be, that is unmistakeable. It is the peculiar
odor of the breath of the milk sick patient. You will know
it by this symptom from any other poison. Indeed, this seems
to be a characteristic mark or symptom belonging to no oth-
er disease, and peculiar to this alone. And if you have
ever witnessed a single case of genuine milk sickness, you
will ever after be able to discriminate between it and any
other.disease, by attending to this symptom, even should all
others be absent.

It is said that the milk from an infected cow emits the
smell of garlic, and when poured on heated iron or burning
coals, it gives off this smell in a very great degree. I have
never tested either the truth or fallacy of the above experi-
ment, and consequently I am not prepared to state the cer-
tainty of it. I suppose though that the above test was insti-
tuted to prove the presence of arsenic in the milk, and to

Dr. Jones on Milk Sickness. 337

substantiate the opinions of some, that the disease is caused
by this metal in some way; for arsenic is said to emit a
garlic like smell when heated, &c. Many have attempted
to prove the presence of arsenic in the milk and butter of
cattle affected with Milk Sickness ; though I believe every
attempt has failed, (from some cause.) I should feel more
confident of success attending efforts to discover the cause in
the water of those springs thought to hold it in solution, or
by the analysis of soils in the various milk sick districts.

In short, my opinion, with all deference to the opinions of
others, is, that the disease is owing to some impurity in the
water. This impurity is most likely a mineral or saline
substance dissolved in the water. Many fountains supposed
to contain the poison have not been analyzed, and it must
be regretted that they have not, as such analysis might
probably have discovered the true cause of the disease.

I shall therefore contend for my position until future re-
searches and discoveries either disprove or establish it
fully.

When an animal is once attacked it rarely ever perfectly
recovers, but is subject to a recurrence on exposure, and in
man it is peculiarly liable to return in the fall of the year.

TREATMENT.

I have witnessed the treatment of but six cases. Four of
these, a Mr. Taylor, his wife and two sons, (before mention-
ed in this essay,) died in a short time. They were treated
as in cases of poisoning from arsenic : sugar and water,
flax-seed tea, lime and water, &c, but without any percept-
ible advantages resulting. The four cases just named, oc-
curred during the days of my pupilage, consequently I was
not qualified to form correct opinions, with regard to the
character of each case, the probability of a successful treat-
ment, and the means best adapted to each case.

Yet, from impressions at that time made upon my mind,
and comparing the appearances of cases coming under my
observation since, with the indelibly marked impression then

338 Dr. Jones on Milk Sickness.

made, I have infered that better success might have followed
the efforts of their attending physician, tinder a course of
treatment differing somewhat from the one pursued by him.
I have not made the above suggestion with a view to detract
any thing from the well-earned character and the fair fame
of the worthy gentleman who treated them, by no means —
the treatment adopted by him was at that time believed to
be most successful. But my object in presenting the above
named cases, is to show the profession that the treatment
adopted and practiced by physicians a few years ago, rarely
succeeds ; and that very considerable improvement in the
treatment of Milk Sickness has been made in the last few
years. In the first of my recollection, Milk Sickness was
thought to be incurable, and a physician would have been
considered presumptuous, or in fact insane, to have asserted
the contrary. At this day, a patient is seldom lost when
under the care of a regular physician. This discrepancy
can only be accounted for in the manner following. 1st.

the disease must have assumed a much milder character
than formerly; or, 2nd, physicians have become much better
acquainted with the proper remedies, — the latter opinion I
consider the most correct.

I do not wish to be understood as altogether condemning
the treatment adopted by physicians some fifteen years ago.
They believed, (or many of them,) that arsenic was the
cause of this disease, and they treated it accordingly. They
were induced to pursue this course from the fact that the
symptoms exhibited in Milk Sickness seemed to be identical
with those produced by arsenic. Indeed, so far as their
opinions with regard to the cause are concerned, I am wil-
ling to admit they are by no means improbable. But their
treatment in the main, so far as I am a judge, was not cal-
culated to counteract the effects even of arsenic.

In the incipient stage of this disease, says Dr. White, "rest,
and some aperient medicine, will generally ward off the
disease." For this purpose, he has found the sulphate of

Dr. Jones on Milk Sickness. 339

magnesia superior to all other remedies. I have witnessed
the good effects of this article in two cases. One of them
a young lady living in the north part of Washington county,
Virginia, who was attacked in the fall of 1839. A young
physician, with whom I am intimately acquainted, was call-
ed to the case, and being urged by him to visit the case, I
consented and accompanied him. We found the young
woman laboring under all the symptoms of Milk Sickness —
pulse quick and faltering — about 75 in i minute — her coun-
tenance peculiarly anxious — somewhat flushed — eyes suf-
fused — her bowels constipated, and cold extremities. She
was harrassed with constant retchings. That peculiar smell
of the breath was also present. This last symptom quickly
enabled us to establish a diagnosis; and having concurred
in our opinions as to the character of the disease, we com-
menced treating the case accordingly. We were induced
to give the Sulphate of Magnesia a fair trial. It was ad-
ministered in large doses every half hour, until the symp-
toms began to abate. I can not say how much was given
at each dose, for we neither weighed nor measured it. By
continuing the magnesia and simple enemata, for a few
hours the case was entirely relieved.

The retching and burning heat in the stomach were the
first symptoms relieved, in the case, after which the pulse
became more natural — the fetid odor of the breath was
soon corrected; also, the rigors or tremors disappeared — the
countenance assumed a natural and healthy aspect, and a
general natural warmth seemed to be rapidly diffused
throughout the whole body. She was advised to continue
the magnesia for a day or two in small doses, at short inter-
vals. She soon recovered her usual health.

Another case occurred a few days after the above, in the
same neighborhood. A boy aged about fourteen years was
attacked in the most violent manner. I was called, (my pre-
ceptor being absent,) and having witnessed the success
attending the treatment of the young lady, I was induced to

340 Dr. Jones on Milk Sickness.

try it in this case. I did so. The Sulphate of Magnesia
was promptly administered, and the case quickly relieved.

I am therefore inclined to consider the Sulphate of Mag-
nesia a superior remedial agent in this disease.

Dr. White says, that some cases treated by this article
alone, where nausea and vomiting had commenced, have
been speedily relieved.

The Dr. says, that when vomiting supervenes, he general-
ly uses camomile tea, which in most cases allays the gastric
irritation. After the bowels, says he, have been evacuated
freely, the patient is considered convalescent, and nothing
more is necessary than to keep them soluble, — this is best
done by the magnesia.

The Dr. remarks, that since he has adopted this practice,
he has not lost a single patient out of some ten or fifteen.
Dr. Shelton advises emetics and cathartics, and bleeds when
the vascular action is high. As an emetic, he advises the
tincture of the euphorbia ipecacuana, to be administered in
the incipient stage, until free emesis is induced.

The superiority of this medicine, he says, over the foreign
article, seems to consist chiefly in its superior purgative
powers — an effect very necessary in this disease. The Dr.,
I believe, finally became partial to the mercurial cathartics
in this disease, notwithstanding he so strongly condemned
them at one time, in a little domestic work written by him
some years ago. [See Shelton's American Medicine.]

Should a case of Milk Sickness come under my observa-
tion at the present time, I would feel some anxiety in testing
the efficacy of the Hydrated Per-Oxide of Iron. Since it
has acquired the character of a specific or antidote to arsenic
or arsenious acid. At least, there could result no harm from
the experiment, in the incipient stage of the disease ; and
should there be a likelihood of its failing, I would immedi-
ately have recourse to some other remedies — the Sulphate
of Magnesia, (Epsom Salts.)

I will close this article by referring in a summary manner,

Prof. Mitchell on Poisons. 341

to opinions not noticed in this essay, entertained relative to
the cause of Milk Sickness, and which I find in a popular
work issued in this state, by Dr. Thomas Anderson.

1st. It has been the opinion of some that the disease is
produced in consequence of the cows eating an immense
number of spiders which inhabit the vegetables upon which
they graze. Those who entertain this opinion, assert that
on visiting the range in the milk sick districts, the vegeta-
tion always appears as it were, "alive and working with
countless millions of spiders of all sizes and colors.

Others, again, ascribe it to some peculiar kind of princi-
ple generated by the concoction and fermentation of a great
variety of vegetables, taken into the stomach of cattle and
other animals, which process of ''concoction and fermenta-
tion/' it is said, combining the qualities of a great variety of
vegetables, produce from these combined qualities, an active
poison, which, contaminating the system, exhibits the fear-
ful disease called Milk Sickness, &c.

I conceive that there are many and insuperable objections
to the above opinions, though I have not the opportunity of
noticing them in the present article. I intend, at some fu-
ture day, to present to the society, some observations on this
subject, of a character somewhat new, and perhaps they
may prove more interesting than any thing noticed in this
article.

Hamilton County, Tenn., Nov., 1848.

Art. II. — Detection of Poisons — Poisonous properties of cer-
tain Organic substances, inferred from their Composition,
by Prof. J. B. Mitchell.

Twenty years ago, the value of chemical examination in
cases of suspected poisoning, was no where fully appreci-
ated by the public; and in many portions of our country it
is yet regarded as a matter of little or no importance. The

342 VroJ. Mitchell on Poisons.

behavior oi those substances most frequently employed in
cases of criminal poisoning, with reagents, is so well under-
stood, and their reaction with appropriate tests so character-
istic, that in judicial examinations no evidence can be more
reliable than the results of a properly conducted chemical
examination. It is not only capable of determining the
presence and nature of the poison, beyond all doubt and un-
certainty, when itexsists inconsiderable quantity; but the
critical inquiries of Christison, Orfila, Taylor and others,
have established processes of such extreme accuracy, that
in most cases, the smallest fraction of a grain can be de-
tected, and in many instances even the exhumed dust of
the victim may furnish evidence to condemn the criminal.

All the ordinary mineral poisons can be discovered and
identified by methods whose certainty and delicacy have
been fully confirmed, and the details of which may be found
in the library of every physician. Chemists found it more
difficult to detect organic poisonous compounds, but the
properties of each of these, have undergone a careful ex-
amination ; and it is now possible to detect and identify an
exceedingly small quantity found in any part of the system.
For the purpose of making known more extensively the
results of some late researches on this subject, I take the
liberty of calling attention to the following article of Prof.
Stass, of Brussels, which I find in the Chemical Gazette,
(London,) and entitled "Observations upon a general method
for detecting the Organic Alkaloids in cases of suspected
poisoning"

"Whatever certain authors may have said on the subject,
it is possible to discover in a suspected liquid all the alka-
loids, in whatever state they may be. I am quite convinced
that every chemist who has kept up his knowledge as to
analysis,will not only succeed in detecting their presence, but
even in determining the nature of that which he has dis-
covered, provided that the alkaloid in question is one of that
class of bodies, the properties of which have been suitably
studied. Thus he will be able to discover coniine, nicotine,

Prof. Mitchell on Poisons. S43

aniline, picoline, petinine, morphine, codeine, narcotine,
strychnine, brucine, veratrine, colchicine, delphine, emetine,
solanine, oconitine, atropine and hyoscyamine. 1 do not
pretend to say that the chemical study of all these alkaloids
has been sufficiently well made to enable the experimenter
who detects one of them to know it immediately, and af-
firm that it is such an alkaloid, and not such another. Nev-
ertheless, in those even which he can not positively deter-
mine or specify, he may be able to say that it belongs to
such a family of vegetables, the Solanaceae for example. In
a case of poisoning by such agents, even this will be of
much importance. The method which I now propose for
detecting the alkaloids in suspected matters is nearly the
same as that employed for extracting those bodies from the
vegetables which contain them. The only difference con-
sists in the manner of setting them free, and of presenting
them to the action of solvents. We know that the alkaloids
form acid salts, which are equally soluble in water and al-
cohol ; we know also that a solution of these acid salts
can be decomposed, so that the base set at liberty remains
either momentarily or permanently in solution in the liquid.
/ have observed that all the solid and fixed alkaloids above
enumerated, when maintained in a free state and in solution
in a liquid, can be taken up by ozither when the solvent is in
a sufficient quantitiy. Thus, to extract an alkaloid from a
suspected substance, the only problem to resolve consists in
separating, by the aid of simple means, the foreign matters,
and then finding a base which, in rendering the alkaloid
free, retains it in solution, in order that the aether may ex-
tract it from the liquid. Successive treatment by water
and alcohol of different degress of concentration suffices
for separating the foreign matters, and obtaining in a small
bulk a solution in which the alkaloid can be found. The
bicarbonates of potash or soda, or these alkalies in a caus-
tic state, are convenient bases for setting the alkaloids at
liberty, at the same time keeping them wholly in solution,
especially if the alkaloids have been combined with an ex-
cess of tartaric or of oxalic acid.

"The above observations do not proceed from speculative
ideas only, but are the result of a pretty long series of ex-
periments which I have several times employed for discov-
ering these organic alkaloids. To put in practice the prin-
ciples which I have thus explained, the following is the

3 14 Prof. Mitchell on Poisons.

method in which I propose to set about such an analysis :
I suppose that we wish to look for an alkaloid in the con-
tents of the stomach or intestines ; we commence by adding
to these matters twice their weight of pure and very strong
alcohol ; we add afterwards, according to the quantity and
nature of the suspected matter, from 10 to 30 grs. of tartaric
or oxalic acid, — in preference, tartaric; we introduce the
mixture into a flask, and heat it to 160 or J 70 deg. F. After
it has completely cooled, it is to be filtered, the insoluble
residue washed with strong alcohol, and the filtered liquid
evaporated in vacuo. If the operator has not an air-pump,
the liquid is to be exposed to a strong current of air at a
temperature of not more than 90 deg. F. If, after the vola-
tilization of the alcohol, the residue contains fatty or other
insoluable matters, the liquid is to be filtered a second time,
and then the filtrate and washings of the filter evaporated
in the air-pump till nearly dry. If we have no air pump, it
is to be placed under a bell-jar over a vessel containing
concentrated sulphuric acid. We are then to treat the
residue with cold anhydrous alcohol, taking care to exhaust
the substance thoroughly ; we evaporate the alcohol in the
open air at the ordinary temperature, or still better, in
vacuo; we now dissolve the acid residue in the smallest
possible quantity of water, and introduce the solution into
a small test-tube, and add little by little pure powdered bi-
carbonate of soda or potash till a fresh quantity produces
no further effervescence of carbonic acid. We then agitate
the whole with four or five times its bulk of pure aether,
and leave it to settle. When the aether swimming on the
top is perfectly clear, decant some of it into a capsule, and
leave it in a very dry place to spontaneous evaporation.

"Now two orders of things may present themselves, —
either the alkaloid contained in the suspected matter is
liquid and volatile, or solid and fixed. I shall now consider
these two hypotheses.

EXAMINATION FOR A LIQUID AND VOLATILE ALKALOID.

"We suppose there exists a liquid and volatile alkaloid.
In such a case, by the evaporation of the aether, there re-
main in the inside of the capsule some small liquid striae,
which fall to the bottom of the vessel. In this case, under
the influence of the heat of the hand, the contents of the
capsule exhale an odor more or less disagreeable, which
becomes, according to the nature of the alkaloid, more or

Prof. Mitchell on Poisons. 845

less pungent, suffocating, irritant; it presents, in short, a
smell like that of a volatile alkali masked by an animal
odor. If we discover any traces of the presence of a vol-
atile alkaloid, we add then to the contents of the vessel,
from which we have decanted a small quantity of aether, 1
or 2 fluid drms, of a strong solution of caustic potash or
soda, and agitate the mixture. After a sufficient time, we
draw off the aether into a test-tube, exhaust the mixture by
two or three treatments with aether, and unite all the aethe-
rial fluids. We pour afterwards into this aether, holding
the alkaloid in solution, 1 or 2 drms. of water, acidulated
with a fifth part of its weight of pure sulphuric acid, agitate
it for some time, leave it to settle, pour off the aether swim-
ming on the top, and wash the acid liquid at the bottom
with a new quantity of aether. As the sul phates of ammo-
nia, of nicotine, aniline, quinoleine, picoline, and petinine
are entirely insoluble in aether, the water acidulated with
sulphuric acid contains the alkaloid in a small bulk, and in
the state of a pure sulphate, but as the sulphate of coniine
is soluble in aether, the aether may contain a small quantity
of this alkaloid, but the greater part remains in the acidula-
ted watery solution. The aether, on the other hand, retains
all the animal matters which it has taken from the alkaline
solutions. If it, on spontaneous evaporation, leaves a small
quantity of a feebly colored yellowish residue, of a repul-
sive animal odor, mixed with a certain quantity of sulphate
of coniine, this alkaloid exists in the suspected matter under
analysis. To extract the alkaloid from the solution of the
acid sulphate, we add to the latter an aqueous and concen-
trated solution of potash or caustic soda ; we agitate and
exhaust the mixture with pure aether; the aether dissolves
ammonia, and, the alkaloid is now free. We expose the
aetherial solution at the lowest possible temperature to
spontaneous evaporation : almost all the ammonia volatil-
izes with the aether, whilst the alkaloid remains as residue.
To eliminate the last traces of ammonia, we place for a
few minutes the vessel containing the alkaloid in a vacuum
over sulphuric acid and obtain the organic alkaloid with
the chemical and physical characters which belong to it,
and which it is now the chemists duty to determine posi-
tively.

EXAMINATION FOR A SOLID AND FIXED ALKALOID.

"Let us now suppose that the alkaloid is solid and fixed ;

346 Prof. Mitchell on Poisons.

in that case, according to the nature of the alkaloid, it may
happen that the evaporation of the aether resulting from
the treatment of the acid matter, to which we have added
bicarbonate of soda, may leave or not a residue containing
an alkaloid. If it does, we add a solution of caustic potash
or soda to the liquid, and agitate it briskly with aether.
This dissolves the vegetable alkaloid, now free and remain-
ing in the solution of potash or soda. In either case, we
exhaust the matter with aether. Whatever be the agent
which has set this alkaloid free, whether it be the bicar-
bonate of soda or potash, or caustic soda or potash, it re-
mains, by the evaporation of the aether, on the side of the
capsule as a solid body, but more commonly as a colorless
milky liquid, holding solid matters in suspension. The odor
of the substance is animal, disagreeable, but not pungent.
It turns litmus-paper permanently blue.

"When we thus discover a solid alkaloid, the first thing
to do is to try and obtain it in a crystaline state, so as to be
able to determine its form. Put some drops of alcohol in
the capsule which contains the alkaloid, and leave the so-
lution to spontaneous evaporation. It is, however, very
rare that the alkaloid obtained by the above process is pure
enough to crystallize. Almost always it is contaminated
with foreign matters. To isolate these substances, some
drops of water, feebly acidulated with sulphuric acid, are
poured into the capsule, and then moved over its surface, so
as to bring it. in contact with the matter in the capsule.
Generally we observe that the acid water does not moisten
the sides of the vessel. The matter which is contained in
it separates into two parts, one formed of greasy mat-
ter, which remains adherent to the sides; the other alka-
line, which dissolves and forms an acid sulphate. We
cautiously decant the acid liquid, which ought to be limpid
and colorless if the process has been well executed ; the
capsule is well washed with some drops of acidulated
water, added to the first liquid, and the whole is evapora-
ted to three-fourths in vacuo, or under a bell-jar over
sulphuric acid. We put into the residue a very concentra-
ted solution of pure carbonate of potash, and treat the
whole liquid with absolute alcohol. This dissolves the
alkaloid, while it leaves untouched the sulphate of potash
and excess of carbonate of potash. The evaporation of
the alcoholic solution gives us the alkaloid in crystals.

Prof. Mitchell on Poisons. 347

"It is now the chemist's business to determine its proper-
ties, to be able to prove its individuality. I have applied
the principles which I have just expounded to the deteclion
of morphine, iodine, strychnine, brucine, veratrine, emetine,
colchicine, aconitine, atropine, hyoscyamine ; and 1 have
succeeded in isolating, without the least difficulty, these
different alkaloids, previously mixed with foreign matters.

"I have thus been able to extract, by this process, mor-
phine from opium, strychnine and brucine from nux vomica,
veratrine from extract of veratrum, emetine from extract
of ipecacuanha, colchicine from tincture of colchicum,
aconitine from an aqueous extract of aconite, hyoscyamine
from a very old extract of henbane, and atropine from an
equally old tincture of belladonna. Thus it is in all confi-
dence that I submit this process to the consideration of
chemists who undertake medico-legal researches. — Bulletin
de V Academic Royal de Medecine de Belgique, Vol. vi. No.
2 ; and Edinburg Monthly Journal of Medical Science,
Sept., 1852."

As the foregoing class of substances is annually enlarged
by discoveries, it is certainly desirable that the physician
should possess some guide to a knowledge of their medici-
nal properties, without resort to experiment, which would
be extremely hazardous, without previous intimation of
their surprising activity. Ii may be true that the efficacy
of remedies never can be certainly determined without trial
of their effects upon the system. But recent inquiries into
the chemical constitution of certain compounds have shown
that peculiar or similar properties sometimes result from
the particular arrangement of their elements.

Perhaps no class of substances furnishes a more remark-
able example of intimate connexion between the chemical
constitution and the medicinal properties, than organic
alkaloids. The theory for the constitution of these bodies,
expressed, as their elements are here arranged, can be sus-
tained by considerations more conclusive than the mere
possibility of such an arrangement.

Nicotine, found in tobacco, has the formula, C 10 H 8 N
which may be expressed, by C, N + C 8 H 8 . But C 2 N is

348 Pr°f- Mitchell on Poisons.

the formula of cyanogen,* and C 8 H 8 is a hydrocarbon, iso-
meric with olefiant gas and ctherine ; and which would be
obtained simply by the removal of two equivalents of oxy-
gen from butyrone, (C 8 H 8 2 .) Nicotine, according to
chemical nomenclature, might be termed octo-hydrocarbu-
ret of cyanogen; but for our purpose, it will be sufficient
to call it the cyanide of hydrocarbon. A single drop of
this compound is sufficient to destroy a dog in a few
minutes; and "small birds perish at the approach of a tube
containing it."

Coniine exists in hemlock; its formula is C 16 H 16 N,
which is equivalent to C 2 N + C 14 H 16 . If C 14 H 16 has
never been separated from its compounds, the same is true
of ethyle C 4 H 5 , (the well known radical of the ether series)
together with several other bases of the same character.
Coniine is, therefore, also the cyanide of a hydrocarbon. "A
drop of this substance injected into the eye of a rabbit, kill-
ed the animal in nine minutes."

Aniline, one of the ingredients of the oil of coal tar, is
obtained fiom indigo by the action of alkalies ; its compo-
sition is C 13 H 7 N, which is eqvivalent to C 2 N + C 10 H 7 .
This compound possesses active properties but little inferior
to the preceding, and it only differs from them in being the
cyanide of different hydrocarbon.

Leukolin is formed with the foregoing in the oil of coal
tar and is separated by distillation. C 2S H 8 N = C 2 N +
C 16 H 8 shows that Us composition is almost identical with
quinoline.

Picoline not only resembles the preceding in its poison
properties, but its formula, C 10 H 1]L N, is also equivalent to
the cynide of a hydrocarbon C 2 N + C 8 H 2 x .

♦Cyanogen is composed of one equivalent of nitrogen and two of carbon
and is among the most remarkable bodies known to chemists. Although
a compound it posseses the properties of a simple substance 3 entering into
combinations with the same energy as elements do.

Prof. Mitchell on Poisons. 319

Amarine (Benzoline,) is formed from the oil of bitter
almonds, (Amigdala amara.) Its constituents C 42 H 18 N 2
may be resolved into two equivalents of cyanogen and one
of a hydrocarbon, 2 C 2 N plus C 3 8 H 1 8 . It is a chrystaline
solid, possessing in an eminent degree the active properties
of the bitter almond.

Quinoline is an artificial product, and was first prepared
by the action of potash on quinine. It is highly poisonous
and may also be expressed by a formula for the cyanide of
a hydrocarbon, C 18 H 7 N = C 2 N plus C 16 H 7 .

The same theory is equally applicable to the oxygenized
alkaloids, in which the oxygen is considered in combination
with a sufficient quantity of hydrogen to form water.

Strychnine is the active principle of the strychnos nux
vomica, S. tjeuta or Upas and other plants of the same genus.
The formula C 44 H 2 4 N 2 4 = 4 H plus 2 C 2 N plus C 40
H 20 . Omitting the water, there remains as in the previous
examples only the. cyanide of a hydrocarbon which is iso-
meric with formyle (C 2 H,) and some other homologous com-
pounds. Not only do the well known properties of strych-
nine entitle it to a rank among poisonous substances, but its
chemical constitution directs to the same conclusion.

Brucine is found associated with the above in some
species of strychnos. Its elements may be resolved into a
similar state of combination, C 44 H 15 N 2 7 = 7 H O
plus 2 C 2 N plus C 40 H 18 ; and its active properties are
only slightly inferior to those of strychnine.

Veratrine exists in the seeds of veratrum sabadilla, in V.
album and some other plants of the same family. By ar-
ranging its elements we have C 34 H 22 N 6 =6HO plus
C 2 N plus C 32 H 16 . As C 32 H 16 has been found native
(koenleinite) it is a very stable compound and it is proba-
ble that veratrine might also be formed artificially. One
grain of veratrine is capable of destroying life.

Colchicine exists in meadow saffron, (colchicum autum-
' nale) in connexion with veratrine, but its properties are

350 Prof. Mitchell on Poisons.

less active. The formula C 41 H 25 N O xl (?) = 11 H O

plus C 2 NplusC 39 H 14 .

Solanine, found in the potato tribe, has the formula C 84
H 6 8 N 2 8 , which may he represented by the cyanide of a
hydrocarbon with twenty-eight parts of water, 28 H O plus
C 2 N plus C 82 H 40 . It is to this substance that the balls
on Irish potatoes and the white stalks of the same, grown
in dark places, as in cellars, owe their poisonous properties.

Narcotine, found abundantly in opium, has the formula,
^46 H 25 N 14 , which exhibits the same constitution as
other substances of this group, 14 H O plus C 2 N plus C 42
H 115 or water cyanogen and a hydrocarbon. The name,
narcotine, (stupefying) designates its prominent effect in
considerable doses upon the system ; it is, however, less dan-
gerous than the preceding.

Narceine = C 28 H 20 N0 12 =12 H O plus C 2 N plus
C 26 H 8 is obtained from the same source and possesses
similar properties.

Morphine — the best opium contains from six to eight
per cent of this alkaloid. Its formula, C 36 H 20 N O, is
equal to 6 H O plus C 2 N plus C 33 H 14 .

Codeine (so called from codeia, a poppy-head) occurs
with Morphine C 36 H 21 N 6 = 6 H O plus C 2 N plus
C34 H 15 .

Opianine, another alkaloid obtained from opium (Egyp-
lian,) C 66 H 36 N 2 21 = 21 HOplus2C 2 NplusC 62 H 15 .

Cotarnine, an artificial product from narcotine, consists
of C 26 .H 13 N O, =5 HO plus C 2 N plusC 24 H 8 .

Cinchonine and Quinine are the two alkaloids in which
reside the active properties of cinchona or Peruvian bark.
The composition of the first is C 20 H 12 NO=HO plus
C 2 N plus C 18 H X1 ; Quinine differs only in containing one
additional equivalent of water.

Caffeine, theine, exists in coffee and tea, C 8 H 5 N 2 2 =
2 H plus 2 C 2 N plus C 4 H 3 . The compound of hydro-

Prof, Mitchell on Poisons. S51

gen and carbon required by this formula is not one of rare
occurrence; C 4 H 3 is the well known radical, acetyle. If
caffeine possesses all the properties which render coffee
so desirable as a beverage, there is little doubt that it would
be prepared artificially by the action of one of the cheaper
cyanides upon some of the acetates. According to the for-
mula, caffeine should be fully as active in its properties as
the alkaloids of opium or Peruvian bark. I have not seen
the results of any experiments with this substance, in its
pure state, upon the system; but if the stimulating effects
of coffee are due to caffeine, it must be exceedingly active,
since one hundred pounds of good coffee yield only about
half a pound of caffeine, or half of one per cent.

Menispermine exists in coculus lndicus=C 18 H 12 0% N
= 2 H O plus C 2 N plus C 16 H 10 . The stupefying effects
of coculus Indicus upon fishes and the intoxicating proper-
ties which it communicates to malt liquors are well known
both in Europe and this country.

Theobromine, from the seeds of theobroma cocoa =C 18
H 10 N 6 4 = 4HO plus C 6 N plus C 14 H 6 ; and aspara-
gine, obtained from the stalks of asparagus = C 8 H 8 N 2 6
= 6 H O plus C 2 N plus C 6 ' H 2 , exhibit a combination
similar to the preceding. If these two substances have
been regarded as incapable of seriously affecting the sys-
tem, because they are formed in articles which are used
with impunity as food, we might for the same reason con-
clude, that morphine and prussic acid are harmless, because
one of them may be obtained from lettuce and the other from
certain portions of several kinds of fruit. It may be infer-
red, however, by comparing all the formula given, that the
two substances are less active than many of the others ; for
it appears that when the proportion of hydrogen to the
carbon is small, the compound is not so energetic if admin-
istered in moderate doses, as when the relative properties
of the hydrogen to the carbon is large. For example in
asparagine the hydrogen is only one-third the quantity of

352 Dr. Moms' case of Foreign Body, <Jc.

the carbon, (C 6 H 2 ,)> but in nicotine the quantity of the
two are equal, (C 8 H 8 .)

In addition to the preceding, other analogous substances
could be given. But a sufficient number has been cited to
show, that if all compounds of cyanogen with a hydrocar-
bon are not capable of destroying life, administered even
in moderate doses, the greatest caution should be exercised
in prescribing articles of this class.

The compounds of cyanogen with some of the metals ap-
pear, also, to act as virulent poisons. But their action may
be owing to a combination similar to those already desig-
nated ; for when any one of the poisonous metallic cyanides
is placed in connexion with organic matter containing ox-
ygen or chlorine, the metal combines with the oxygen or
chlorine, while the cyanogen takes its place, forming
the cyanide of a hydrocarbon. When, for example, hy-
drochloric ether is distilled with cyanide of potassium
a reaction ensues, in which a volatile and exceedingly
poisonous liquid is formed. The following are the changes
which ensue: C 2 N K plus C 4 H 5 CI = K CI plus C 6
H 5 N, in which C 2 N, C 4 H 5 is the poisonous com-
pound. By a similar reaction of cyanide of potassium
upon an oxyde of acetyle we would have caffeine. In
those metallic cyanides which are not regarded as poisonous
(as the ferro-cyanide of potassium ); the affinity of the
metals for the cyanogen is so strong that they will not
easily separate from and leave the C 2 N free to form a hy-
drocarbon combination.

Art. III. — Foreign body near the valves of the Aorta — Death
after two years — reported by Morcun Morris, M. D., of
New York city.

The following case is interesting, from the fact of a for-
eign body remaining in such close proximity to the valves
of the Aorta and partially imbedded in the substance of the

Dr. Morris 9 case of Foreign Body, fyc. 353

heart, for so long a period without producing any derange-
ment of either the arterial orvascular systems. The injury
was received in March, 1840, and the patient died August
2, 1842, a period of two years and three months intervening.

In March, 1840, J. C, a German, aet. 58, was aroused in
the night, by some person forcing one of the panels of the
window shutter. The patient upon getting up and looking
out of the broken shutter received the contents of a gun or
pistol in his chest, and fell immediately upon the floor.

A wound was found, upon examination, situated between
the third and fourth ribs, about two inches to the left of the
sternum, of a small size, perfectly round and resembling
that produced by a ball ; no ball could be discovered upon
probing the wound, and, according to the patient's account,
the subsequent symptoms were only such as would follow
any wound, except, to use his own words, "he had Inflam-
mation of the Lungs for several weeks subsequent, and
then recovered and attended to his gardening as usual."

During the summer of 1841, was called to see the patient
suffering with an alarming Hemorrhage from the Lungs;
at this time there was a short tickling irritating cough —
respiration hurried — some feverishness and night-sweats ;
there was dullness on percussion over the whole of the left
lung, and, in fact, all the symptoms of Phthisis. The patient
continued much in the same state notwithstanding treat-
ment until August, 1842, the disease gradually progressing
towards a fatal termination, with all the attendant symp-
toms, when on the 2d of August, 1842, he suddenly sank
and died.

Autopsy, six hours after death.

Upon making an external examination, a cicatrix, corres-
ponding to the before described wound, was found.

Upon opening the cavity of the Thorax, the Pleura was
everywhere adherent to the walls, upon separating which,
the lungs of both sides were found softened and filled with
cavities of pus and Tubercles in almost every stage ; the left

354 Translation — Poisoning by Atropine, <J*c.

lung much the most disorganised. No trace of any foreign
substance could be discovered. The heart was next exam-
ined, and just behind the insertion of the Aorta between it,
and partially imbedded in the substance of the heart, was
found a slug, very rough and ragged on its surface, encassed
in a firm, fibrous sheath. The heart was slightly Hyper-
trophicd and softened, but presented no other lesion. All
the viscera of the abdomen were perfectly healthy.

It is remarkable that a slug should remain in that posi-
tion, in the substance of the heart, in such close proximity
to the valves of the Aorta, and yet produce no untoward
symptom whatever, as is evident from the history of the
case, for such a length of time.

Art. IV. — Poisoning by Atropine applied to the Conjunctiva
— Recovery — Use of Fowler's Solution in St. Vitus 1 Dance,
and in Catalepsy — and Death by Chloroform, translated
for the Record, by Dr. P. Fatio, Knoxville.
We find in many authors cases of poisoning, by "Bella-
donna Atropa," (deadly night-shade,) in consequence of its
absorption in very "minim" doses. But the following case
is remarkable, not only on account of the small quantity
used, but on account of the place of absorption of the Atro-
pine. It is with a very healthy mucous membrame, "the
conjunctiva," that this dangerous medicament has been put
in contact.

This case happened last August, in the hospital of St.
Antony, at Paris, France. A man had entered said hos-
pital, laboring under a Cataract, complicated with adhe-
rence of the Iris to the Crystalline Lens.

On the 31st of August, the physician, so as to be permit-
ted to examine more completely the state of the eye, instilled
into each corner of the eye three or four drops of a solution,

Translation — Poisoning by Atropine, <£c. 355

made out of five centigrammes of Atropine, and thirty
grammes of water acidulated with acetic acid.

One half an hour after this operation, the patient was
taken with swimming of the head, and said, he felt that
something strange was taking place within him. Forty-five
minutes later all the symptoms of poisoning by Belladonna
appeared: face red and animated ; eye balls, though very
irregular, enormousl} 7- dilated ; constant hallucination. The
patient is drawing his bed clothes over him and is trying to
catch some imaginary bodies that are fluttering around his
head. He makes efforts to get up, but his legs tremble and
give way under him, and it is entirely impossible for him to
walk two steps without being supported. The pulse is full,
marking 120 pulsations.

Towards the evening he appears to be in a quieter state,
but the bladder is so much distended that there is no possi-
bility of micturition ; the Catheter was then resorted to.

During the night of the 1st of September, the hallucina-
tions were of such a nature and of such a frequency, that
it was found necessary to tie the patient in his bed.
Towards the morning he is quiet and able to answer the
various questions made to him ; the tongue is moist ; the
face less flushed. A little stupor and quickness of the pulse
are still noticed.

September the 2d, the night was an excellent one, but in
the morning some hallucination and confusion of mind are
still perceptible; the gait remains uncertain and stagger-
ing ; eye-balls are still dilated; micturition easy; organs
of digestion in good order.

All those symptoms vanished progressively, but it was
only on the fourth day after the instillation of the solution
of Atropine that the patient recovered entirely his normal
state. Being asked by the physician upon what had hap-
pened to him during the three preceding days, he appeared
to have only a very distant idea of his delirium. — Abeille
Medicate.

356 Translation — Poisoning by Atropine, fyc.

use op fowler's solution in st. vitus' dance and in

catalepsy.

A medical journal of Courtray, France, contains some
communications of Dr. Hollman, a physician of Edam, in
Holland, where, this gentleman says, that he has been using
Arsenic in various diseases. The observations of this phy-
sician are certainly imperfect, but, such as they are, they
are worthy of notice and consideration by the practitioner.

A young boy, aet. 14, of scrofulous habits, and who
had already been afflicted with Rachitis, was laboring
under an incipient tuberculous Phtisis — "Phtisis Pulmona-
lis" — and at the same time presented all the symptoms of
Chorea. The Doctor, having first struggled with the pul-
monary affection, conquered it by means of the Cod Liver
Oil, assisted by an analeptic regimen ; resorted, against the
Chorea, to Fowler's Solution of Arsenite of Potassa, the
patient took six drops of it daily, and under this treatment
recovered rapidly.

Another case: A young woman, aet. 22, of chlorotic
habits and afflicted with worms, was daily subject to cata-
leptic fits. During all the access, this woman remained in
the same position, that she had at its beginning. She was
at first treated for Helminthiasis and Chlorosis ; recovered
of these two diseases ; but was still subject to Catalepsy.
The Doctor employed all the remedies generally in use with
this disease, but all was in vain. At last, he concluded to
try Fowler's Solution ; after having gradually been brought
to take lOgut. daily, the patient was freed, of one or two
of her periodical fits; and by continuing and increasing the
dose to 15gut. daily, she was free of spells for a week. But
unhappily, at this time, she was obliged to quit the use of this
solution, on account of the weak state of the stomach, and
the attacks again made their appearance. Having treated
the disorder of the stomach and brought it back to its equi-
librium, he again resorted to the solution, and, with all
possible care, and after having used the same with laudable

Prof. Mitchell on Mineral Waters. 357

perseverance, for a long time, the patient was blessed with
an entire recovery.

DEATH BY CHLOROFORM.

One case of death has lately taken place in the hospital
of Orleans, France. The subject was a young soldier, who
has been operated upon for a Lipoma of the face. He
died (if the information is correct) in five minutes after
having been subjected to the influence of Chloroform, and
all the efforts made to save him were frustrated.

Art. V. — Analysis of Montvale Spring — Efficacy and prop-
erties of Mineral Waters, by J. B. Mitchell, Professor of
Chemistry, in East Tennessee University.
The following is an analysis of water sent me from
Montvale Springs, by Mr. Watson, the proprietor. Owing
to the imperfect manner in which the jar, containing water
designed for the determination of its gases, was closed, they
could not be determined. The carbonic acid given is the
amount estimated from the carbonate of lime and iron
present.

One gallon contains

Grains.

Sulphuric Acid, 54.12

Lime, 37.98

Magnesia, 4.08

Soda, 3.00

Iron, Peroxide, 1.66

Chlorine, 1.10

Alumina .50

£ otash ' M „ I traces

Organic Matter, )

Carbonic Acid, 6.74

The following is the state of combination calculated for
the above results.

358 Prof. Mitchell on Mineral Waters.

Grains. Grains.

Sodium, .77 ) ^ chloride of Sodium h96

Chlorine, 1.19 )

ci°i a 'A -j n'n l or Sulphate of Soda, 4.51

Sul. Acid, 2.54 ) l

Magnesia, 4.08 ) e , , ,. ',, . 1orkA

c ,° A -i - n ~> [ or bulph. of Magnesia, ]2.00

Sul. Acid, 7.92 ) r

o i a -j io'iii. ( or Sulphate of Lime, 74.21

Sul. Acid, 43.66 ) l *

Lime, 7.43) n u * r j • too*

n \ . , _ QO > or Carbonate of Lime, 13.26

Car. Acid, 5.83 ) '

Iron, protoxide, 1.49 ) n , . , T Ari

n a -i m 1 or Carbonate ot Iron, 2.40

Car. Acid, .91 ) '

Alumina, .50, in suspension, (?) .50

Total. 108.84

Water may very appropriately be styled the great thera-
peutical agent of materia medica. The want of a full ap-
preciation of its virtues has no doubt contributed largely to
the popularity, if it did not lead to the origin of the "water
cure" theories. The value of a remedy is not unfrequently
estimated from its complexity, while one of greater value
is discarded merely on account of its simplicity. When
the captain of the "king's host," was commanded by the
prophet to wash seven times in the river Jordan, he went
away in a rage, because he expected that some great tiling
would be told him. In our day, it is too simple a prescrip-
tion to expect relief from a remedy that gushes in exhaust-
less abundance from our hills and valleys. But when
compounds and compositions doubly combined from all the.
elements of the animal vegetable and mineral kingdoms
are proclaimed as panaceas and specifics, the demand is
often so eager that it must be supplied even in defiance of
"patent privileges," or appeased by imitations of the "only
genuine article."

The efficacy of water as a curative agent may de-
pend upon its temperature — its power as a solvent and
dilutent, which applies to all waters suitable for bathing or

Prof. Mitchell on Mineral Waters. 359

drinking. But, besides these, other waters holding certain
mineras in solultion, exercise a more active and direct in-
fluence in relieving and curing numerous physical derange-
ments. And in addition to the usual medicinal properties
of these ingredients, they often enhance the efficacy of
water as a solvent, by communicating to it a quality that
permits its use in very copious draughts. The best ordinary
drinking water can not always be taken in very large
potions, without producing unpleasant symptoms ; but many
mineral waters can be used in exceedingly large quantities
without any injurious consequences. This alone must be
regarded as a valuable property, aside from the influence
of the ingredients to which it is due. In hundreds of cases
disease results from obstruction of those minute vessels and
pores, which are designed to remove from the system its
useless products and impurities. When large potions, of
such water, are frequently administered, it acts more
promptly as a solvent, tends more powerfully to penetrate
these minute vessels and even assists, mechanically, to dis-
engage and wash away any obstructions. As consequen-
ces of this mode of action, we should expect to witness
increased perspiration, following the use of large quantities
of mineral water ; or, when the obstructions resist solution
and mechanical removal, we are not surprised to learn, that
occasionally cutaneous eruptions or other inflammatory
symptoms occur among visitors at such places of resort.

The peculiar and distinctive virtures of a mineral water,
without long and repeated trials of its effects on various
forms of disease, can only be predicated upon a knowledge
of the separate and combined properties of the ingredients
retained in solution. But, even with this knowledge, the
efficacy of such natural combinations would generally be
underrated. Medicines in the form of powders, or concen-
trated solutions, will frequently pass through the alimentary
passages with only partial absorption. Mineral waters are
more easily and rapidly introduced to the blood vessels, and

S60 Prof. Mitchell on Mineral Waters.

thence to all the minute branches of the secretory appara-
tus, and in this manner their ingredients may be rendered
eminently active, while the same remedy, administered in
another form, would be wholly inert. A long course of ob-
servations, under the most favorable circumstances, by an
eminent physician, Dr. Johnson, led to the conclusion, that
"Saline, and aperient mineral waters, will produce ten times
more effect, than the identical materials artificially com-
bined. A grain of iron, as it eixists in chalybeate water, is
more tonic than twenty grains exhibited according to the
pharmacopseia."

If, therefore, the peculiar medicinal properties of a mine-
ral water are due to the substances in solution, and
especially, if they possess such increased energy of action,
it is certainly a matter of no small importance, that an
analysis should be furnished of any spring offered to the
public, in order that the invalid might form some judgment
of its adaptation to his case, or the physician prescribe in-
telligently for the particular wants of his patients.

No comment need be offered the physician, upon the re-
sults of the preceding analysis, of Montvale Spring ; but for
the unprofessional reader a few observations may not be in-
appropriate, relative to the properties of some of the ingre-
dients found in that water.

Sulphuric acid which is present in larger quantity than
any other ingredient, is a valuable tonic and astringent.
During convalescence from any acute or protracted disease,
it is employed with the most happy results in improving
the appetite and in assisting digestion. As an astringent,
it has been found useful in general laxity, arising from
derangement of the mucous membranes of the stomach or
intestines; also, in Hemorhages, and especially in profuse
perspiration, even in the worst stages of pulmonary
diseases.

How eminently calculated, is a remedy of this character,
to relieve that large class of debilitating disorders, occasion-

Prof. Mitchell on Mineral Waters. 361

ed by the heat of summer; and to remove the lingering
the prostration, which, so often, restricts the invalid to nar-
row limits of his apartment.

More recently it has been discovered that sulphuric acid is
an efficient remedy in acute and chronic Diarrhea and Chol-
era Morbus. For examples of its superior excellence in these
most unpleasant and often dangerous complaints, the reader
is referred to a valuable communication in the first number
of this journal, by Dr. James Rogers, whose recommenda-
tion would alone be sufficient to establish a high reputation
for this new application of sulphuric acid. But I have
been informed, by the editor of the Record, that the late
numbers of many other medical journals, also, contain
reports confirming the value of sulphuric acid, in diseases
of that character. For a highly successful mode of its
administration, no better reference can be given than the
communication of Dr. Rogers.

It is certainly true that we do not understand the influ-
ence which the vital principle exercises in operating
chemical changes upon substances within the system. But
we do know that there is a strong tendency to the formation
of phosphate of lime, since it constitutes so large a portion
of the animal frame. From the fact, that sulphate of lime
as such, does not appear so essential to life or health, we
are prepared to believe that the sulphuric acid would seek
other combinations, and resign, a portion of its lime to
phosphoric acid known to be diffused through the system.
At least we do know that phosphate of lime is formed out
of the system, when phosphoric acid or any soluble phos-
phate is added to a solution of sulphate of lime. So much
has recently been written upon the value of phosphate of
lime as a remedy, that we would only recommend con-
sumptives and those scrofulously affected to make a trial of
its efficacy at Montvale Springs.

Carbonate of Iron is too well known as a tonic, and sul-
phate of Magnesia as an aperient to require particular

S62 Prof. Mitchell on Mineral Waters.

notice. If the quantity of these be suspected as too small
to produce any sensible effect, we are reminded that the
celebrated waters of Buxton, Eng., have proved, from the
record of nearly 19,000 patients, to be highly stimulating
and tonic ; and yet, it contains altogether only 14| grains
of saline matter to the gallon, viz: "10.5 of carbonate of
lime; 2.5 of sulphate of lime, and 1.5 of muriate of soda."
The active properties which have given to Brighton its
world-wide reputation, are due to 31.7 Sul. lime, 11.2 Sul.
iron, 12.2 muriate of soda, 6 of muriate of magnesia, and
1.1 of silica.

The peculiar efficacy of Sul. Acid as a tonic after any
acute disease — its beneficial effects in derangements of the
mucous membranes — its power to stimulate the appetite
and aid digestion — its potent virtue in Diarrhea and kindred
complaints — also, the bracing properties of carbonate of
iron — the well known value of sulphate of magnesia and
chloride of sodium — add to this the great probability, that
a portion of the lime is converted in the system to phosphate
of lime, offers to the invalid a natural combination — a pre-
scription of nature — that is worthy of a careful trial, and
may afford relief, "when all other remedies fail." But in-
stead of relying entirely upon the nature of the ingredients,
in order to determine what benefits, may be expected from
the use of Montvale water, the numerous cases of decided
improvement and cure of invalids, who have gone there
from various quarters, from different climates — whose phys-
ical Condition displayed an extensive variety of cases — fully
confirm the highest opinion which we might justly entertain
of its curative powers.

It should be understood that the object of this communi-
cation was not to extol the springs ; but to give the analysis
and, with it, some of the prominent effects which we might
expect to follow its use. These expectations are only con-
firmed by the report of patients.

It is a matter earnestly desired, that medical men, partic-

Dr. Morns' case of Foreign Body, fyc. 363

ularly in East Tennessee, would study the effects of the
natural combinations, as found in mineral waters in their
vicinity, upon various classes of disease. To succeed in
this to any great advantage, it may be necessary for them
to make, or themselves undergo the expense of an analysis.
The benefit which might result to the community, would
many times repay the trifling outlay, and would much con-
tribute to develope the resources and treasures which yet
repose concealed within the mountain boundaries of the old
State of Frankland.

364

Ramsey's Report,

MAY, 1852.

Diseases.

Measles,

do
Urticaria,
Fever Intermit.,

do
Neural. Intermit.,
Constipation,

do
Colic,

do
Diarrhea,
Cholera Morbus,
Cholera Infantum,
Hemorrhoids,
Cough Senile,
Bronchitis,
Consumption,
Pneumonia
Convulsions,

do
Leucorrhea,
Uterine Ulcer,

do
Mennorrhagia,
Abortion Thr't'd,
Placental Ret.,
Parturition,
Ret. of Urine,
Rheumatism,
Accidents,

do
Felon,

(Edema Uvula,
Hydrocephalus,
Ex.Uter.Foetat'n,

SICK.

DEATHS.

g^undei

pi M

r 15
F

15to35

over 35

To-
tal.

un.15

15to35!ov.25

M'F

4
1

2
1

w
b

1
1

I 4

1
1

}•»

w
b

1
1

2
1

To-
tal.

Measles. — Female, set. 25. Was called to this case four
days after the appearance of the eruption, because of her
apprehension of Inflammation of the Bowels. Her bowels
had been regular since her sickness, until the night before
the morning of my call, when she took Castor Oil, "only
because somebody told her that any one with Measles must
take Oil or Salts." J found her in a semi-erect position in bed,

Ramsey's Report. 365

respiration very rapid, pulse small and beating 108, and
occasionally coughing. From the first symptoms of illness
she had sore throat, which had not been mitigated by the
appearance of the eruption. On asking, why the position
had been assumed ? she replied, "to get my breath, and it
has been so ever since I was taken ; and I spit up blood?"

Now, here was a condition that the physician would
readily recognise on entering the room, as Intercurrent
Pneumonia, as it was demonstrated to be, on physical ex-
amination ; and which was permitted to continue for many
hours, notwithstanding the very great difficulty of breath-
ing attending it, and until the operation of an useless and
foolish prescription occasioned alarm, and the physician to
be called. Calomel and Opium was administered and
followed by Sir. Hyd. Potass, with happy result.

Neuralgia Intermit. — A resident of St. Louis, on a visit
to his former home, had suffered for several weeks ; had
blistered, bled and purged before Dr. M. saw him. Four
5 grain doses of Quinine gave perfect relief.

Diarrhea. — Some cases in children teething ; some in
convalescents from Measles ; and some from evident errors
of diet.

Pneumonia. — A female, set. 20, anaemic, suppressed men-
struation. Blisters, Sir. Hyd. Potass, followed by Iron,
relieved the attack. She had afterwards Hemorrhage from
the Lungs, which was suppressed by hot Pediluviae, and a
liberal use of Ipecac.

Convulsions. — Yellow female aet. 45, under great mental
excitement ran three-fourths of a mile, and fell convulsed.
She had never been so affected before. The convulsion con-
tinued about two hours and left her maniacal, which persis-
ted for full twenty-four hours, when she fell into a profound,
but calm sleep, after which, she was well. A purgative in-
jection and antispasmodic agents constituted the plan of
treatment.

Yellow female, aet. 12 months: Death. I was called to

306 Ramsey 9 s Report.

this case on the 10th, 21st and 29th, but never saw it
spasmed, nor could I, at either of my first two visits, dis-
cover any departure from health, the child being relieved
before I reached it, and seemingly perfectly well when I
examined it, and it died before I could get to it on the 29th.
On the 10th and 21st it was crying, on the 29th it was ly-
ing very calm in its mothers lap, in the open air, at the door
of the house, when it became convulsed. The mother said
it had always been in the habit, when very angry, of hold-
ing its breath ; and the master was of the opinion that it
was choked, on egg-shell, on the 10th, and he thought he
had destroyed the attack by running his finger down the
child's throat. The second was relieved, as he thought, by
throwing cold water in the child's face ; and the third was
the occasion of death, before the messenger sent to call me
had time to reach my office. The only symptoms were
absence of all evidence of breathing and clenched hands. He
saw the three attacks, and they were identical.

Meigs, the younger, after Rillet, Barthez and Ranking,
has called attention to this form of convulsive seizure, and
advances the belief that it is "of quite common occurrence."
It appears to be the result of a sudden spasm of all the re-
spiratory, muscles, so that the child ceases to breathe, from
which circumstance, no doubt, it has received its name
of Holding-breath Spell.

I have seen three well-marked cases : one a yellow girl,
now set. 23, epileptic, highly sensitive, and who is some-
times convulsed, by very positive ebulition of temper, or
commotion of feelings. During her childhood, the spasm
amounted to nothing more than a sudden and complete ces-
sation of all respiratory movement, with apparent want of
consciousness. She became an epileptic at about 14, and
though plump, and well developed, and seemingly very
healthy, she yet is subjected to attacks, and her mind is
unaffected. She has never gestated, though she has been
in intercourse with a man for more than five years.

Ramsey's Report. 367

Another is a white male, set. 2 years. Excitement of
temper is very frequently cut short by a holding-breath
spell. He is the subject of Eclampsia — being universally
convulsed — the attacks causing very great prostration.
But the holding-breath spells occasion his parents no un-
easiness — they are common, do not last very long, and are
usually relieved by any sudden impression made on the
senses of the child. And the third is the case of the tables.

If I am correct in considering this case as one belonging
to the class of convulsions in which I have placed it, the
observation of Dr. Meigs, that "they never occur sponta-
neously" is not sustained. Not being able to refer to the
writers that he mentions, I am left, but without any knowl-
edge of the number of cases by which they sustain the
conclusion, to suppose that the opinion of their spontaneous
occurrence, is also held by them. But even admitting a
very extended number of cases to have occurred to these
practitioners, it is after all, but a point of observation, and
a spontaneous holding-breath spell, observed but once is
sufficient to establish the fact, that such attacks may occur.
And, indeed, are they not of relatively frequent occurrence ?
I have, some where, seen the opinion advanced, that very
many young infants, whose deaths have been ascribed to
"over-laying" by the nurse or mother, really deceased from
a sudden effusion upon the brain. May it not be asked,
were not many of these cases of death from the spontane-
ous occurrence of a holding-breath spell ? Some months
ago a yellow woman of this town, who had been delivered
of a child, prematurely, but which lived, and seemed to be
well, though puny for four weeks, was sitting in a chair
suckling her child, and talking to another women. The child
sucked until satisfied, when she laid it in her lap. After a
few minutes she took it up, dead. How it died, or why it
died, no one could tell. It certainly could not have been
eonvulsed, for if the other women had not have seen, the
mother would have felt any convulsive action of her child

3G8 Ramsey's Report.

laying- as it was, in her lap. Did it not die from a sponta-
neous cessation of respiratory movement ?

These suggestions are advanced for the purpose of
attracting more attention to this particular form of convul-
sion, as it is very evident that, heretofore, but little effort
has been made to study its features — but four cases having
been published before Meigs considered it.

Hydrocephaloid. — Female set. 9, fatal. This child had
recovered from Measles, and re-commenced her duties at
school. From her earliest infancy she has been considered
by her parents as the sickly member of the family; and her
appearance now, as compared with children of the same
age, in no particular militates against the opinion. Alto-
gether, it indicates a long continuance of ill-health — very
small frame, thin visage, rotten teeth, pale surface, red
cheek, and general physique very delicate. She was, never-
theless quite sprightly, pert, intelligent and ordinarily affec-
tionate, but very much indisposed to physical exertion, since
the real or apparent convalescence from Measles, the erup-
tion of which did not appear for six days after the first
symptoms of the attack. The disappearance of the erup-
tion left her with some muscular strength, cool surface, little
or no appetite, and laggard circulation, which condition was
very materially destroyed by the use of Iron, the Liq. Oxy.
Sulphate being the form of the medicine administered.

She w r as displaced from my visiting list as a patient with
Measles, on the 23d of March; on the 31st the Iron was
ordered, on account of the general condition refered to before;
and on the 18th of April I was hastily called after night to
see her. She had been to school during the day, and an
hour previous, was seemingly so well that her parents were
not restrained from paying an evening call to a neighboring
family. During their absence, she was discovered to be
sitting in her chair with her jaw pendant, and saliva freely
running from her mouth. The cause of alarm had subsided
before my arrival, and I found her cool, with a fine, soft, quick

Ramsey's Report. 369

pulse, and slightly nervous, as evidenced by an unwonted
suspiciousness, and twitching of the tendons. During the
attack she was totally devoid of consciousness, and com-
plained alone of headache after consciousness was regained.

She was subjected to three such attacks, each succeeded
by headache, including that which has been described prior
to the fourth of May. These occurred on the 18th, 23d and
30th of April, and an obscure exacerbation in frequency of
pulse, during the evenings, was believed to prevail after the
first attack. This led to the employment of salicine, and
under its use each succeeding attack seemed to be more mild,
the appetite improved, and there was less indisposition to
physical exertion.

There was apparent improvement each successive day
since the last attack, until May the fourth, after a very vio-
lent headache, which had subsided alter some hours, during
which Valerian and Watery Sol. of AssafoBtida had been
used. At 3 P. M., she had another attack, in every par-
ticular resembling that which has been described, except
that the muscles to a very slight degree of violence, were
spasmed; and after a few moments of loss of consciousness,
a constant application of her hand to her throat, which
manifestation was observed during the length of her sick-
ness, and a flexure of her right leg; tongue coated white
and thick, bowels sufficiently regular — under the impression
of Castor Oil and Turpentine; urine very scantily secreted,
except after a dose containing Turpentine — pulse 56.

After this attack she grew progressively worse. —
Brandy, a stimulating diuretic liniment, constituted the
treatment until her pulse became more frequent, though it
never became either full, wiry, or hard; but a thread-like
stroke, quick, very weak, and very compressable, character-
ised it, until a few hours before her death,when the frequency
very gradually disappeared, until pulsation was wholly lost.
After forty-eight hours from the attack, she became rest-
less, and the right thigh, which had remained flexed, though

370 Ramsey s Report,

not immovable, was constantly extended and flexed, and
the right arm, though sometimes at rest was generally in
motion. The left leg and arm, ordinarily extended, and
only occasionally moved — often enough, however, to satisfy
us that paralysis, if at all, did not positively prevail ; sen-
sibility did not seem to be impaired — she brushes flies from
her surface with her hand, and swallows with some difficulty
anything which is put in her mouth, though the listlessness
is so profound that for thirty-six hours she has given no ev-
idence of knowledge of any transpiring circumstances, has
not articulated or groaned, or moaned, and lies with the
eyes half closed. Under these circumstances, the kidneys
were freely moved, the bowels copiously discharged, one
worm being passed, and the skin became moist. The treat-
ment consisted of Iod. Potass and beef tea.

After these apparently favorable symptoms were observ-
ed, she occasionally roused up from the profoundness of her
listlessness — the constant motion of right limbs, and almost
as constant rest of the left, was much less marked — her eyes
opened and followed different persons about the room; the
pupils were dilated, the conjunctiva white, perpectly free
from any appearance of injection, pulse 95, heat not discov-
erably warmer than should be, feet and hands warm, ancles
and wrists cool. Ice water was so placed as to drip on the
head, and after its commencement the heat of the surface
became diffused and increased, and the pulse attained a beat
of 110 to the minute. The evidences led to the use of cal-
omel in small doses — ice internally, the first bit of which
she broke between her teeth, and attempted for the first
time since the first forty-eight hours to speak. Under the
use of the ice water and calomel, her pulse continued to
increase in frequency, and twenty-four hours after this addi-
tion to the treatment, her skin was very comfortably moist,
and her bowels and bladder freely and favorably dis-
charged. During the whole attack, five worms were dis-
charged — one at a time.

Ramsey's Report. 371

The case continued under observation without any per-
ceptable change for several days, until May 15th, slight
spasmodic movements of the arms were occasionally ob-
served during the morning. She was noticed to be breathing
short once or twice, followed by a long deep breath, and a
moment's pause for a short time previous to her death, which
occurred at 1 P. M. 15th.

The treatment of the cases consisted of brandy, animal
broths, and agents directed to the Kidneys, for which Iod.
Potass was the one most relied on, until the very posi-
tive evidences of a degree of reaction induced the use of
calomel. It was given for three days, the idea of debilitat-
ed vital powers not being lost sight of, and of course the
main features of the treatment originally instituted perse-
vered in.

We are free to confess the case presents some very in-
teresting points for reflection. Some of the symptoms, as
the constant motion of the right leg, and the same constancy
of rest of the other leg, are, in themselves, not unworthy of
very profound investigation; but we leave them. And in-
stead of any sort of research to establish any particular
ideas which the case may have originated in our own mind,
and which, under, other circumstances, we may publish, we
transfer to our pages as the very best commentary, and as
best adapted to the enlightenment of those who have follow-
ed us through the history of the case, a chapter from the
small but invaluable work of that very eccentric man, Dr.
Gooch, whose suggestions, so far as our intercourse with
practitioners is concerned, are not known, or if known, are
not sufficiently apprecaited.

"I remember when a boy reading a story of two knights-
errant who arrived on the opposite sides of a pedestal sur-
mounted by a shield; one declared it was gold, the other
that it was silver ; growing angry they proceeded to blows,
and after a long fight, each was thrown on the opposite
side of the shield to that where he began this fight — when
both immediately detected their error ; the knight who had

372 Ramsey- s Report

said it was silver finding that on the opposite side it was
gold, and the knight who had said it was gold finding that
on the opposite side it was silver. This story a little modi-
fied, is a good illustration of the state of medical opinion
in this age, perhaps in all ages : medical men have no oc-
casion to tilt, for they all throng on one and the same side
of the shield ; they look only at the golden side, and never
dream of the possibility that on the opposite side it may be
of a different metal.

In observing disease two sets of symptoms may be noticed,
which are mixed together in the case, but which require to
be discriminated to form a correct opinion of it: the one
consists of the striking symptoms which form what may be
called the physiognomy of the disease ; the other consists
of those symptoms which indicate the morbid state of or-
ganisation on which the disease depends ; the former only
are noticed by the common observer, but the latter are the
most important, and the skillful physician takes them for
his guides in the treatment. "He notices not only where
the hour hand of nature's clock points, but also the run of
its minute and second hands."

Two patients complain occasionally of dimness of sight,
swimming of the head, singing in the ears, and observe that
if they turn the head on one side to look at an object they
feel as if they should fall ; but the one is plump, florid, and
has a full pulse ; the other is pale and thin, has cold hands
and feet, and a pulse small and feeble. One practitioner
bleeds them both ; the other bleeds the one, but does all he
can to give blood to the other. The latter cures both his
patients ; the former cures the one, but ruins the health of
the other ; but such is the nature of the human mind, that
the cases/or a preconceived opinion are retained easier than
those against it. He remembers his good deed, forgets the
other, 6r calls the case "anomalous," and marches on, with-
out the slightest doubt that bleeding is the universal and
sovereign remedy for dimness of sight, swimming of *he
head, and singing in the ears, save and except only in "an-
omalous" cases.

I am anxious to call the attention of medical men to a
disorder of children which I find invariably attributed to,
and treated as, congestion or inflammation of the brain, but
which 1 am convinced often depends on, or is connected
with, the opposite state of circulation.

Ramsey's Report. 373

Symptoms. — It is chiefly indicated by heaviness of head
and drowsiness; the age of the little patients whom I have
seen in this state has been from a few months to two or
three years; they have been rather small of their age, and
of delicate health, or they have been exposed to debilita-
ting causes.

Physical characters, age and influences. — The physician
finds the child lying on the nurse's lap, unable or unwilling
to raise its head, half asleep, one moment opening its eyr-s,
and the next closing them again with a remarkable expres-
sion of languor.

Tongue, skin. — The tongue is slightly white, the skin is not
hot, at times the nurse remarks tha: it is colder than natural ;
in some cases there is at times a slight and transient flush :
the bowels I have always seen already disturbed by pur-
gatives, so that I can scarcely say what they are when left
to themselves: thus the state which I am describing is
marked by heaviness of the head and drowsiness, without
any signs of pain, great languor, and a total absence of all
active febrile symptoms.

The cases which I have seen have been invariably at-
tributed to congestion of the brain, and the remedies
employed have been leeches and cold lotions to the head,
and purgatives, especially calomel. Under this treatment
they have gradually become worse, the languor has in-
creased, the deficiency of heat has become greater and
more permanent, the pulse quicker and wenker, and at
the end of a few days, or a week, or some'imes longer,
the little patients have died with symptoms apparently of
exhaustion. In two cases, however, I have seen, during
the last few hours, symptoms of oppressed brain, as coma,
stertorous breathing, and dilated and motionless pupil.

I will relate a case as a specimen. A little girl, about
two years old, small of her age and very delicate, was
taken ill with the symptoms which I have above described.
She lay dozing, languid, with a cool skin, and a pulse rath-
er weak, but not much quicker than natural. She had no
disposition to take nourishment. Her sister having died
only a week before of an illness which began exactly in
the same way, and which was treated by leeches and pur*
gatives ; and some doubts having been entertained by the
medical attendant of the propriety of the treatment, leech-
es were withheld, but the child not being better at the end

374 Ramsey's Report.

of two days, the parents, naturally anxious about their only
surviving child, consulted another practitioner. The case
was immediately decided to be one of cerebral congestion,
and three leeches were ordered to be applied to the head.
As the nurse was going to apply them, and during (he ab-
sence of the medical attendants, a friend called in who had
been educated for physic, but had never practised it, and
who had great influence with the family : he saw the child,
said that the doctors were not sufficiently active, and ad-
vised the number of leeches to be doubled. Six, therefore,
were applied ; they bled copiously ; but when the medical
attendants assembled in the evening, they found the aspect
of the case totally altered, and that for the worse ; the
child was deadly pale, it had scarcely any pulse, its skin
was cold, the pupils were dilated and motionless when light
was allowed to fall on them, and when a watch was held to
its eyes it seemed not to see ; there was no squinting. Did
this state of vision depend on the pressure of a fluid effus-
ed into the brain since the bleeding, and during this exhaus-
ted and feeble state of circulation, or did it depend on the
circulation of the brain being too languid to support the
sensibility of the retina? It is well known that large loss-
es of blood enfeeble vision. I saw a striking instance of
this in a lady who flooded to death. When I entered the
chamber she had no pulse, and she was tossing about in
that restless state which is so fatal a sign in these terrific
cases. She could still speak, asked whether I was come
(she knew I had been sent for,) and said, "Am I in any
danger '? — How dark the room is ! — I can't see." The shut-
ters were open, the blind up, and the light from the window
facing the bed fell strong on her face. I had the curiosity
to lift the lid and observe the state of the eye ; the pupil
was completely dilated, and perfectly motionless, though
the light fell strong on it. Who can doubt that here the
insensibility of the retina depended on the deficiency of
the circulation ? But to return to the little patient. The
next day she had vomited her food several times ; it was
therefore directed that she should take no other nutriment
than a dessert spoonful of ass's milk every hour, and
this was strictly obeyed, and continued for several days.
The child wasted, her features grew sharp, every now and
then she looked fretful, and uttered a faint squeaking cry;
the eye-balls became sunk in the socket, like those of a

Ramsei/s Report. 375

corpse that had been dead a month; the skin continued
cool, and often cold, and the pulse weak, tremulous, and
sometimes scarcely to be felt. Under this regimen, and in
this way, she continued to go on for several days. At times
she revived a little, so as to induce those who prescribed
this treatment to believe confidently that she would recov-
er, and she clearly regained her sight, for if a watch was
held up to her, she would follow it with her eyes. She
lived longer than I expected : a full week, and then died
with the symptoms of exhaustion, not with those of oppress-
ed brain. The head was opened by a surgeon accustomed
to anatomical examinations, and nothing was found but a
little more serum than is usual in the ventricles.

If the reader has perused the foregoing case attentively,
and has reflected on it, he will of course draw his own
inferences. I can draw no others than these, that the
heaviness of the head and drowsiness, which were attribu-
ted to congestion in the brain, really depended on a defi-
ciency of nervous energy ; that the bleeding and scanty
diet aggravated this state, and insured the death of the
child ; that the state of the eye which so speedily followed
the loss of blood, and which resembled that occasioned by
effusion, did in reality depend on a deficiency in the circu-
lation of the brain, a fact of considerable curiosity and
importance.

I will now relate a case similar in the symptoms, but
very different in the treatment and result. I was going
out of town one afternoon, last summer, when a gentleman
drove up to my door in a coach, and entreated me to go and
see his child, which he said had something the matter with
its head, and that the medical gentleman of the family was
in the house, just going to apply leeches. I went with him
immediately, and when I entered the nursery I found a child,
ten months old, lying on its nurse's lap, exactly in the state
which I have already described ; the same unwillingness
to hold its head up, the same drowsiness, languor, absence
of heat, and all symptoms of fever. The child was not
small of its age, and had not been weak, but it had been
weaned about two months, since which it had never thriven.
The leeches had not been put on. I took the medical gen-
tleman into another room, related to him the foregoing case,
and several similar to it, which had been treated in the
same way, and had died in the same way. Then I related

376 Ramsey's Report.

to him a similar case which I had seen in the neighboring
square, which had been treated with Ammonia in decoc-
tion of bark and good diet, which had recovered ; not slowly,
so as to make it doubtful whether the treatment was the'
cause of the recovery, but so speedily that at the third visit
I took my leave. He consented to postpone the leeches
and to pursue the plan which I recommended. We directed
the gruel diet to be left off, and no other to be given than
ass's milk, of which the child was to take, at least; a pint
and a half, and at most a quart, in the twenty- four hours.
Its medicine was ten minims of the aromatic spirit of Am-
monia in a small draught every four hours. When we
met the next day, the appearance of the child proved that
our measures had been right ; the nurse was walking about
the nursery with it upright in her arms. It looked happy
and laughing ; the same plan was continued another day ;
the next day it was so well that 1 took my leave, merely
directing the Ammonia to be given at longer intervals, and
thus gradually withdrawn, the ass's milk to be continued,
which kept the bowels sufficiently open, without aperient
medicine.

So inveterate is the disposition to attribute drowsiness in
children to congestion of the brain, and to treat it so, that
I have seen an infant, four months old, half dead from the
Diarrhea produced by artificial food, and capable of being
saved only by cordials, aromatics, and a breast of milk ;
but because it lay dozing on its nurse's lap two leeches had
been put on the temples, and this by a practitioner of more
than average sense and knowledge. I took off the leeches,
stopped the bleeding of the bites, and attempted nothing
but to restrain the Diarrhea, and get in plenty of nature's
nutriment, and as I succeeded in this, the drowsiness went
off, and the child revived. If it could have reasoned and
spoken,* it would have told this practitioner how wrong he
was : any one, who from long delect in the organs of nutri-
tion, is reduced, so that he has neither flesh on his body, nor
blood in his veins, well knows what it is to lay down his
head and doze away half the day without any congestion
or inflammation of his brain. This error, although I have
specified it only in a particular complaint of children, may
be observed in our notions and treatment of other diseases,
and at other periods of life. If a woman has a profuse
hemorrhage after delivery, she will probably have a dis-

Ramsey's Report. 377

tressing headache, with throbbing in the head, noises in the
ears, a colorless complexion, and a quick, weak, and often-
thrilling pulse, all which symptoms are greatly increased
by any exertion. I have seen this state treated in various
ways, by small opiates, gentle aperients, and unstimulating
nourishment, with no relief. I have seen blood taken away
from the head, and it has afforded relief for a few hours,
but then the headache, throbbing and noises have returned
worse than ever ; the truth is, that this is the acute state of
what in a minor degree and in a more chronic form occurs
in Chlorosis, by which I mean pale-faced Amenorrhea,
whether at puberty or in after-life. It may be called acute
Chlorosis, and like that disease is best cured by steel, given
at first in small doses, gradually increased, merely obviating
Constipation by aloetic aperients.

I shall not encumber this paper with a multiplicity of
cases, but state that the above are only specimens of a
class of which I have seen enough to convince me that
they deserve the attention of the profession. If I had any
doubt about this, this doubt would be removed by the
fact that Dr. Marshall Hall has already recognised them,
and described them in a paper which had been read at
the Medico-Chirurgical Society. He has, therefore, antici-
pated me in announcing them, but so far from regretting
this, I am glad to support my statements by the authority
of so observing and reflecting a physician. The only dif-
ference between our experience seems to be this — that he
attributes the state which I have been describing to the
Diarrhea produced by weaning, or to the application of
leeches for some previous complaint. In most of the cases
I have seen, however, the child has had no previous illness,
and the leeches have been applied subsequent to the drow-
siness, and as a remedy for it.

The children who were the subjects of this affection, and
were thus treated, died not with symptoms* of oppressed
brain, but with those of exhaustion, and on examining the
head after death, the blood-vessels were unusually empty,
and the fluid in the ventricles rather in excess : in two in-
stances death was preceded by symptoms of effusion, viz :
blindness, a dilated pupil, coma and convulsions ; and after
death the ventricles were found distended with fluid to the
amount of several ounces, the sinuses and veins of the
brain being remarkably empty. I believe the prevalent

378 Ramsey's Report.

ngtion of the profession is, that all sudden effusions of wa-
ter into the brain are the result of inflammatory action ;
but putting aside for a moment this dogma of the schools,
consider the circumstances of this case. For several days
before death, all that part of the circulating system which
was cognisable to the senses, was at the lowest ebb consis-
tent with life, and after death the blood-vessels of the brain
were found remarkably empty of blood, and the ventricles
unusually full of water. From such facts I can draw no
other inference than this, that this sudden effusion was a
passive exudation from the exhalents of the ventricles
occasioned by a state of the circulation the very opposite
to congestion or inflammation. This is corroborated by
the dissection of animals which have been bled to death.
Drs. Saunders and Seeds, of Edinburgh, found that in ani-
mals bled to death, whether from veins or arteries, there
was found more or less serous effusion within the head, and
Dr. Kelly thus expresses himself: "If instead of bleeding
usque ad mortem we were to bleed animals more sparingly
and repeatedly, I have no doubt that we should succeed in
draining the brain of a much larger quantity of its red
blood ; but in such experiments we shall, I think, find a
larger effusion of serum." # # # # "Though we can
not, by general depletion, entirely or nearly empty the vas-
cular system of the brain as we can the vessels of the
other parts of the body, it is yet possible by profuse hem-
orrhages to drain it of a sensible portion of its red blood,
that the place of this spoliation seems to be supplied both
by extra and intra vascular serum, and that watery effusion
within the head is a pretty constant concomitant or con-
sequence of great sanguineous depletion." But if this is
true, it is of great practical importance, for if we take
delicate feeble children, and by bleeding and purging for an
imaginary congestion of the brain, reduce their circulation
to a very low ebb, and keep it so, we run the risk of pro-
ducing that very effusion of serum into the brain which we
are endeavoring by our remedies to prevent. The follow-
ing case, though I would not cite it as one of the class
which I am describing, still bears upon the question of
passive effusion into the brain.

A little girl, about three years old, small of her age, del-
icate in health, and wayward in disposition, was taken ill
with the following symptoms : she could not hold her head

Ramsey's Report. 379

up, lay dozing, for the most part, and complained occasion-
ally of momentary pain at the top of the head. Her skin
was cool, she had little disposition for food, her pulse was
76, not intermitting but irregular ; neither light nor noise
were disagreeable to her. Leeches were applied to the
temples twice, and she was purged daily, but the treatment,
after a week, had afforded no relief to the symptoms. The
vertex was now shaved, and six leeches applied where she
complained of pain, a cold lotion was applied frequently to
the vertex, and she took a grain of Calomel every four
hours for two days. The leeches bled well, and the Calo-
mel operated freely, but without affording any relief to the
symptoms ; the pulse too lost its slowness and irregularity ;
it became weak and quick, about 130. In this state, the
little girl still continuing to complain of pain in her head,
six more leeches were applied to the vertex, making in all
two dozen, and purging was continued. The next day she
appeared much altered; she was pale and cold, and fainted
on being raised. Depleting remedies were now altogether
discontinued, and her diet was mended though liquid, but
she contined weak and faint, and the next day was convuls-
ed. She-, was insensible, her limbs were stiff, her eyes
drawn to the left side, not both eyes turned towards the
nose, but both turned to the left. As she could not swallow,
all that was done was to warm her, for she was cold, and
to inject a glyster containing Spirits of Turpentine. After
a few hours the convulsions ceased, she came to herself
with perfect vision, and the natural appearance of the eye ;
she talked, took nutriment, but still complained occasionally
of pain on the head. The next day she was so much better
there seemed a fair prospect of her recovery. She was at
this time taking no medicine, and feeding on equal parts of
gruel and milk, or gruel and veal broth. As two days had
passed without the bowels being moved, a solution of
Salts in infusion of Senna was given, and this not operating
after eight hours, she took two drachms of the compound
decoction of Aloes. The next morning she had one stool,
but that an enormous one, and soon after became comatose,
with a dilated pupil, stertoreous breathing, and palsy of
the left side. In the evening she died ; two weeks and
three days from the beginning of her illness. The next
morning the head was opened, by Mr. King, of Regent
street, formerly Iterne at the Hotel Dieu at Paris, and

380 Ramsey's Report,

Teacher of Anatomy, to whom I am indebted for several
valuable dissections : the following are his notes of the
examination. The vessels of the dura mater were quite
empty ; along the two posterior thirds of the superior lon-
gitudinal sinus the two plates of the arachnoid membrane
adhered by a white substance like cheese ; it was limited
to the extent of the sinus laterally; there was no injection
in the vicinity of this lymph; the sinuses were empty ; the
veins of the pia mater were remarkably empty, and this
membrane was pale ; the substance of the brain was
remarkably pale; under the arachnoid membrane a thin stra-
tum of limpid serum was effused. The ventricles were full
of the same fluid, and a little distended by it. In all, there
was not more than an ounce and a half of serum. On the
surface of the ventricles two or three veins, rather large,
were evident.

How far our opinion about the nature of the case may
be modified by the white cheesy substance in the arach-
noid membrane ; whether the mode of treatment was
wrong, or, on the contrary, right, but not prompt and active
enough ; on these points I shall not offer a conjecture : but
when I consider, 1st, the low ebb at which the circulation
was kept for several days before death ; 2d, the emptiness
of the blood-vessels of the brain discovered after death ;
and 3d, that the symptoms of oppressed brain did not occur
more than twelve hours before death ; I can not refrain
from inferring that this sudden effusion of water was not
an active exudation from vessels in a state of congestion,
but a passive exudation from empty and feeble exhalents.

I do not expect that medical men will take my word as
conclusive* evidence for the truth of this paper, neither do I
wish it ; all I ask is that they will allow my observations and
reasonings to induce them to look out for similar cases and
judge for themselves. With regard to the point, that heav-
iness of •head and drowsiness of children often depend not on
congestion, but on deficiency of nervous power, and require
for their cure not depletion, but support, I am quite satis-
fied that candid observers will find that I am right. With
regard to the other point, that sudden effusion of serum
may take place in the brain from a state of the circulation,
the opposite to congestion or inflammation, it is more likely,
even if true, to be overlooked ; for such is the force of pre-
conceived opinion, and such the prevalent notions on the

Ramsey's Report. 381

subject, that the following will be the process in most
minds. A child has been suffering some obscure symp-
toms for many days, when suddenly and unexpectedly it
becomes blind, its pupils are dilated and motionless, it be-
comes convulsed, comatose, and dies. On opening the head
serum is found in the ventricles, and without any further
inquiry it is immediately taken for granted, that this effu-
sion was the effect of overlooked inflammation of the brain,
and regret is felt that active depletion had not been em-
ployed : the inference may be a correct one ; all I contend
for is, that it should not be taken for granted, but that those
circumstances should be minutely inquired into which
throw light on the state of the circulation in which the ef-
fusion occurred.

It is surely impossible for the reader to mistake me so
far as to suppose that I am denying the important practical
truths, that heaviness of head and drowsiness in chil-
dren commonly depend on congestion, and are to be reliev-
ed by depletion, and that acute Hydrocephalus is a serous
effusion, the result of inflammation, and capable of being
cured only in the inflammatory stage by bleeding and purg-
ing. These vital truths I would state as strongly as any
man, but there are opposite truths. All that I mean is that
these symptoms sometimes depend, not on congestion,
which is to be relieved by bleeding, but on deficient ner-
vous power, which is to be relieved by sustaining remedies.
All I advise is, that not only the heaviness of head and
drowsiness should be noticed, but the accompanying symp-
toms also, and that a drowsy child, who is languid, feeble,
cool, or even cold, with a quick weak pulse, should not be
treated by bleeding, starving and purging, like a drowsy
child who is strong, plethoric, has a flushed face, perhaps
swelled gums, and a heated skin. The case which I have
been describing "may not improperly be compared to cer-
tain species of plants, by no means uncommon, which are
liable to be confounded with others by an inattentive
observer."

Extra- Uterine Fatation. — Mrs. B. aet. 25. First Gestation.

This case has been referred to in tables of a previous month,

under the head of threatened abortion. The patient had

led an irregular life prior to marriage, which relation she

assumed three years before her attack, and since according

382 Ramsey's Repoi^t.

to the testimony of all most familiar with her, she has been
constant to her husband. Her person is very large, and she
was, when first placed under observation, seemingly in good
health. Her menstrual discharge was reported as regular
since marriage, until within the four months immediately
preceding the date of the first professional visit, and she has
considered herself since the discovery of the suppression, as
pregnant. The suppression has been followed by enlarge-
ment of the breasts, and perceptible abdominal increase.

Some weeks after the suppression, and while on a visit in
the country, she experienced severe pain in the lower por-
tion of the abdomen, and at the same time had a sanguineous
discharge from the vaginal carfd. A subsequent attack
occurring after several weeks, was the occasion of Dr. Mc's
visit. The nature of the attack deserves especial mention.
She was standing in the floor, and as she believed, in every
particular, in good health, when suddenly she grasped her
sides with her hands and cried, "I'm cramping to death,"
and w r ould have fallen, but for the timely assistance of two
female companions who were present, and by whom she
was put to bed. Frequent and distinctly intermitting pains,
each one accompanied with, or causing a sanguenious vag-
inal discharge. Opium was administered and the recum-
bent posture enjoined.

For several days no report was received at the office, of
the condition of the patient, and we considered- her as
relieved, which was the fact. She left her bed the next day
after Dr. Mc's visit, and employed herself in her ordinary
occupation as house-wife to a laborer.

Two other attacks, at intervals of several days occurred
prior to the 24th of April — the date of the commencement
of the record of the case — in all respects similar to that
which has been described.

On the 24th of April, Dr. Mcintosh being absent, I re-
sponded to an urgent call to visit Mrs. B., and found her
with severe, frequently occurring paroxysmal pains, located

Ramsey^s Report. 883

in the back and lower portion of the abdomen, a slight bloody
discharge from the vagina, and constant uneasiness of the
abdomen, but more particularly of the hypochondrium, and
close to the pubes, bowels healthily open, skin soft, with a
gentle glow of warmth, for several days had constantly
experienced some difficulty in urinating.

On instituting an examination, almost immediately on
penetrating the vagina, the finger came in contact with a
projection, which conveyed the idea, by its size and shape
to the feeling, of a cow's teat. The finger was, with ease,
passed between the vaginal Walls and the tumor, which ap-
peared to come from behind and to the left of the pubes.
Deep back, and to the right side, I was confident of feeling the
uterus — the examination being made with the left hand —
most certainly a projection with an orifice, and distinct from
that which has been described. The teat-like projection re-
ceived pressure without any sensation of uneasiness, which
was not the case with the part presumed to be the womb.
Within half an hour Dr. Mcintosh made the same discove-
ries, except that while he was positive that the teat was not
the womb, he was not confident that the other projection
was that viscus. Opium and rest, as before, constituted the
prescription that we made, together with an order for every
passage and every discharge to be closely examined with a
view of detecting the product of conception.

The opium procured respite, and with it a decrease of the
quantity of the discharge, but the pain yet presented in par-
oxysms. Nothing except the bloody discharge passed
from the vagina. Because of our doubt as to the nature of
the unusual formation detected at our last visit, we institut-
ed a speculum examination, using a bi-valve, but could not
discover any thing at all abnormal. The womb, however,
was too far within for us to consider ourselves as having
mistaken its descent as something unnatural. The cervix
was very pale, the os-tinca3 round, and very little open,
with a membranous substance hanging from it, which we

884 Ramsey's Report.

extracted without any force whatever being used; it was
thin, angular and tough, and considered by us to be the deci-
dua. Before removing the speculum, we introduced, with-
out any difficulty, Simpson's Uterine Sound into the cavity
of the womb, to near the third inch. Under the use of the
opium the pains were allayed, and for forty-eight hours she
remained comfortable, when again the same character of
pain and discharge occurred. The opium, to meet this fresh
outbreak of symptoms, now becoming of more than ordinary
interest, was ordered in more positive doses, and with effect.
For more than thirty-eight hours she remained free from
pain, except occasional slight paroxysms, and an unpleas-
ant sensation of more or less intenseness, and which has
been constant for several days, situated in the left hypochon-
driac region, and which she thinks is extending.

During this respite she discovered an enlargement to the
left of the pubes, which was distinctly recognized at times
by others, and again could not be distinguished. At this
time Dr. M. suggested Extra-uterine faetation as the only
satisfactory assumption, from the whole circumstances of
the case; and we think a careful review of its history con-
firms the suggestion as correct.

The respite from suffering was terminated by the presen-
tation of other symptoms. We found her lying on her
left side, and she affirmed herself to be unable to lie on the
right, or on her back, from the painful tension and pressure
occasioned — she said — by the swelling in the left hypochon-
driac ; legs flexed ; abdomen — which had remained until
within a few hours free from tenderness even, or distension
— painful, and she declares "it comes from that swelling ;"
countenance pallid ; pulse rapid ; respiration short and
quick. On enquiry, the women, of whom there were sev-
eral constantly with her, most positively affirmed, that she
had not, from the first, lost more than three half pints of
blood, if so much, and that it yet continued, though to a
.very slight extent. The accession of these symptoms was

Ramsey's Report, 385

sudden, and the pain commenced in "the swelling" and was
extending throughout the abdomen. Turpentine fomenta-
tions were sedulously employed,Opium liberally administer-
ed, and Calomel with Ipecac were given in combination, at
intervals deemed suitable.

For twenty-four hours these symptoms continued with
progressive violence, when the abdomen became tympanitic
and very sensitive, more especially over "the swelling," the
respiration more natural, pulse 160 — the patient evidently
sinking. Porter, Broth, Oil and Turpentine, Opium and
Cinnamon constituted the treatment instituted under this
state of the case. The practitioners of the town, without
exception, were, at this period invited to see the patient, and
to hear the history of her condition — she was seen by three
of them.

Under the impression of these agents, the abdomen became
soft, except immediately over the seat of "the swelling,"
respiration quiet — surface moist and cool, very positively so
on the forehead — pulse very rapid. Twelve hours after this
condition was observed, the abdomen was perfectly flaccid,
free from pain or sense of distention, and a tumor some-
what acumated, was very obvious to the left of, and above
the pubes ; respiration slow, extremities bathed in cold
perspiration, pulse barely perceptible, and constant dis-
charges from the bowels.

The patient lived five days after the appearance of the
seemingly desperate symptoms just mentioned — hiccough,
vomiting, and tympanities, at times presenting — subjected
to the same general treatment which has been given. Hoff-
man's Anodyne, Ether and Camphor, were occassionally
used in the place of opium, as our judgment directed. She
died at six o'clock, in the morning. A post mortem could
not be obtained.

I have been particular, it may be to tediousness, in giving
the history of this case. But I have done so because it is of
a character, that, fortunately, is seldom presented to the

386 Ramsey's Report.

observation of practitioners, and this is sufficient, if any
apology is necessary.

The case was one either of ovarian disease or extra-
uterine pregnancy; and though the intimate symptomatol-
ogy of these conditions are much assimilate, yet the
uniform good health which the patient enjoyed until the at-
tack of sudden pain, and faintness, together with an almos t
total immunity from any evidences of disease during the
intervals of the attack, is enough to cause one to lay aside
rationally, the consideration of ovarian disease. This, in
connection with the menstrual suppression for three months
or more, after their regular flow for three years, and the
suppression not being preceded, attended or followed by
any interruption of wonted health, the gradual increase of
size and the enlargement of the breasts, though under some
circumstances insufficient as criterions, are in this case
abundant, to satisfy the mind that the patient was three
months or more advanced in gestation.

This conclusion being adopted, we must believe that the
several attacks, which were successively presumed to be
threatened abortion, were occasioned by the irritation in-
duced by the necessity of the tissue which contained the
product of conception, to adapt itself to the progressive
growth of the embryo. It is hardly possible to believe that
the several attacks were the evidence of a rupture of the
membrane, tubal or otherwise ; and we feel assured that
no one will assume that the embryo was thrown off at
either of the attacks preceding that which terminated with
the life* of the patient. And as regards the last one, we
have the assertions of females who were particularly
charged to examine closely, and we believe that directions
were closely obeyed, that nothing of the kind had been
passed off; and besides, the continuance of periodic pains,
until the very last, and other circumstances, will be receiv-
ed as positive proof that the cause from which they first
originated, was present, and exerting its influence up to
within a short time preceding death.

Ramsey's Report, 387

The reasons for the conclusion, that the cause was an
error in place of the product of conception are

First, the evidences that conception had occurred.

Second, the sudenness and character of the attacks.

These were each time, without premonition, and without
any assignable cause, as is fully illustrated by the first
attack to which professional attention was invited. The
patient was standing in the floor, conversing with some
female acquaintances, in the enjoyment, as they all thought,
of full health, when suddenly, without a previous complaint,
she grasped her sides and cried out with pain, and would
have fallen but for the support given her by those who were
with her. Periodic pains, and a discharge of a red fluid,
followed this suddenness of attack. An interval of several
days of uninterrupted health succeeded, and then another
attack occurred as unexpected as the first one was. And
finally, during one of these attacks, at a time when inflam-
matory symptoms were by no means positive, and the
severity of the pain was mollified, a sudden quickening of
respiration, and of the pulse, with coolness of the surface,
and exacerbated pain, and distinctly originating in, and
extending, radiating from a particular point, followed by a
distended and highly sensitive abdomen, and wholly unable
to assume any other than one particular position which
produced some alleviation of her agony.

Conception being established, as a fact, by rational signs,
in a woman, "and thereupon when having attained to the
middle of the second or to the third month, be seized with
horrible pain in the hypogastrium and pelvis, turn pale,
lose the pulse and faint, I should suspect the rupture of a
tube-sac of extra-uterine pregnancy. # * * But in case
they should continue and increase, with signs of concealed
hemmorrhage so as to leave no doubt of imminent death,
/ think the diagnosis could not be other than a ruptured
tube-sac of gestation" This is quoted from our own Meigs,
and though the language does not embrace all the active

388 Ramsey's Report.

attendants upon extra uterine foetation, it is explicit, and
fitted to the case under consideration. Lea, one of the
great obstetricians, of London, in speaking of particular
cases that had fallen under his observation, says : "The
usual symptoms of early pregnancy had been observed in
all of them, and before the occurrence of acute pain in the
region of the uterus, followed by faintness, coldness of the
extremities, hurried respiration and death, there was no
ground for suspecting that the ovum was not contained
within the uterus ;" and in another article he gives these
same symptoms as diagnostic of extra-uterine (tubal)
pregnancy. But, notwithstanding, this summing up, if as
I think, the ,case now recorded belongs to the class in
which we have placed it, there are symptoms mention-
ed by others in detailing their cases, which were ob-
served in this, and which I must regard as entitled to
distinction in a consideration instituted to determine the
character of a pregnancy. These are in connection with
periodic pains, if of sufficient violence, the non-expulsion of
an embryo, and the existence of a red colored or sanguineous
discharge. In the several cases recorded by Meigs, if we
mistake not, there is not a single one, in which this dis-
charge escaped observation ; and there are several cases
recorded in medical journals of different dates of publica-
tion, to which I have access, and which I have carefully
read, with a view to satisfy my own mind as to the force
of this discharge as a symptom of the unnatural condition
ascribed as the cause of our patient's death, and we do not
rememoer a single recorded case in which its presence is
omitted to be noticed. And this dignity is given to it by
Ramsbotham in the language which is quoted here, "the
uterus takes on itself expulsive action, which is attended
with pain similar to the throes of labor, and during these
pains the deciduous membrane is expelled from the cavity,
with a slight sanguineous discharge" And again, "* * *
which are evidenced by the spasmodic pains * * # accom-

Ramsey's Report. 389

panied by some sanguineous discharge." These manifes-
tations to my mind are very important, more particularly
if they occur in connection with a constant sense of unea-
siness at a particular point of the abdomen — abnormal
gestation must be suspected. Repeated symptoms of
abortion, embracing amongst them, a red colored discharge,
whether mild or severe, should make the practitioner ap-
prehend the existence of extra-uterine pregnancy, and
induce an intimate inquiry to satisfy his mind, if possible,
before the onset of those alarming and almost hopeless
evidences defined by Meigs and Lea. If this is done, the
judicious practitioner can place his patient under such a
prophylactic course, as will give her system more ability to
withstand the shock of peritonitis, and respond more fa-
vorably to the remedies which may be employed for its
subjugation; as for internal hemorrhage it can neither be
prepared for anticipately, nor checked by remedies when
induced by the rupture of the containing tissues, in extra-
uterine pregnancy.

Not having had sufficient observation in cases of this
character, we can not assume position with either those
who affirm that the cavity of the womb is decidulously
lined, or with Lea, and those who, with him, contend that
such an opinion is an assumption. But one thing I can say,
whether it was as the language of Ramsbotham, of Meigs,
and of others, would lead me to suspect, deciduous, or
whether it was, in the words of Velpeau, "a concrescible
matter which is a morphus," amembrane was most] cer-
tainly expelled from the cavity of the womb of this patient.

Statistics show that the largest number of extra-uterine
pregnancies are tubal. Judging alone from the symptoms,
this case sustains the statistics establishing the majority of
cases of tubal pregnancy as occurring on the left side.
Some writer, whose article on this subject we have read,
says, that it occurs five times out of seven on the left side ;
and in reference to these cases recorded by Meigs, every

390 Ramsey's Report.

one of them were pregnancies of the left fallu opian tube.
And so far as statistics can be applied to the elucidation of
symptomatology in cases of this class, it must be regarded
that our patient was the subject of tubal pregnancy of the
left side. And this opinion derives support from the fact
that the serious evidences of an unusual condition presen-
ted but a short time after the third month since the ces-
sation of the menstrual flux ; for all observers agree
that tubal pregnancies rarely ever pass beyond the third
month, while other species of extra-uterine pregnancy may
continue from six months to very many years.

The character of the teat-like projection which at first
gave the examinaing attendants so much uneasiness, and
which subsequently we could not detect, is without doubt
fully explained by the following quotation, at least our
minds were perfectly satisfied of its elucidating force as ap-
plied to the circumstances of our patient, which forced us
to make reference to the records of the profession. Rams-
botham says: "On making an examination per vaginum,
the os uteri may be raised so high by a portion of the
child's body occupying the pelvis, as to be beyond the reach
of the finger; and if it can be touched, the uterus will be
found unimpregnated, though rather larger and heavier
than in its virgin state ; with the cervix not at all, or but
slightly developed. A foot or hand of the child, or some
other portion of its body, may occasionally be felt through
the coats of the vagina."

There are other points of interest which have been pre-
sented to us, during the consideration of this case. But
we will Hot make special reference to them now ; for if the
record of the case possesses any value, it will be proven by
the careful re-examination which practitioners will make
of the chapters on extra-uterine foetation in the systematic
treatises on obstetrics, and the more anxious search into
journals containing records of special cases.

Note. — These notes will be continued in numbers of the Southern
Medical and Physical Journal, published at Nashville.

ECLECTIC AND SUMMARY.

Any thing from the pen of Dr. Deaderick merits preser-
vation in the home journal. We are sorry that the Doctor,
with his preeminent qualities, should never have given
more of his medical knowledge for the benefit of the pro-
fession. [Ed. Record.]

From the Southern Journal of Medical and Physical Sciences,
CONTINUED FEVERS.

A/thens, Tenn., January 10, 1853.

Dr. W. P. Jones — Dear Sir : Your letter of the 24th
ult., requesting a history of Continued Fevers, as occurring
in my practice, was duly received ; but the expectation
expressed, that I have it in my power to impart important
information in that respect, will indeed, I fear, be but very
partially realized, mainly for the following reasons, to wit :
First, not being very partial to my profession, and having
more congenial pursuits at command, I at various times
broke off from it, and would not practice except occasion-
ally when urgent cases were pressed upon my attention,
and moreover kept no regular record of professional occur-
rences. Secondly, Jefferson and adjacent counties, where
by far the greatest part of my desultory practice occurred,
are remarkable for their salubrity ; the face of the country
mountainous and hilly ; the soil dry, rocky and gravelly ;
the water (a great portion limestone,) excellent, and the
streams, large and small, passing rapidly off over gravelly
or rocky beds. Consequently we were seldom or never
assailed by the epidemics incident to marshy and miasmatic
countries. In a course of more than twenty-two years I do
not believe that I met with more than a dozen cases of In-
termittent Fever. The most frequent were the common
Remittent and Continued (synocha) Fevers, which seemed
incidentally to be occasioned by frequent rains succeeded
by a bright sun and sultry weather. In general these Fe-
vers required a free use of the lancet, the proper applica-

392 Eclectic and Summary,

tion of which, in conjunction with other appropriate
appliances, rarely failed in conducting them to a favorable
termination. It may be added, that straggling cases of
Typhus were occasionally met with. Some twenty years
since I moved to McMinn county, about one hundred miles
south west of my former residence. Here the face of the"
country is by no means so mountainous and broken.
On the contrary there is in every direction consid-
erable bodies of level land, upon the uncultivated part
of which, the water in many places, after copious rains,
remains until dissipated by evaporation and absorption.
The water courses pursue their sluggish course over muddy
bottoms, and during the winter and spring seasons innu-
merable wet weather springs and rivulets which disappear
in summer are every where seen. With this dissimilarity
in the local features of the two sections under notice, there
exists a corresponding difference in the characteristics of
their febrile diseases. Intermittents are vastly more fre-
quent, and in the Remittent and Continued Fevers there is
an unequivocal approximation to the character of those in
more decidedly paludal and miasmatic regions.

Iu the Fevers here, the force and excitement in the san-
guineous system are not so exalted, the thirst and heat of
the body less ; nevertheless a greater tendency to conges-
tion and inflammation in some of the viscera, especially in
the mucous membrane of the intestines, and convalescence
more tedious. In short, many of the cases might be per-
haps with propriety termed Typhoid ; consequently more
caution is requisite in the use of the lancet, which is rarely
admissible, excepting at an early period of the attack. But
according to my humble experience, when thus applied, it
will in a large proportion of cases prove highly beneficial
in obviating congestion and inflammation in vital organs,
which* seem to be the principal causes of a fatal termina-
tion. Indeed I have from time to time met with many
instances of such like, which I could hardly doubt would
have resulted differently, had an early and free abstraction
of blood been premised. The rose colored spots and suda-
mina of which you speak, I do not remember to have
noticed in any of my own cases, and one of my medical
friends whom I have consulted, reported the same- thing,
and another as having met with only one or two examples
of the kind. An here again I must be permitted to express

Eclectic and Summary* 393

the impression that if in the early stage of the complaint,
bleeding and a strictly antiphlogistic remedial and dietetic
course were pursued, the phenomena spoken of would not
often appear.

Your letter came to hand just as I was folding up one in
answer to a circular and request from Dr. Avent, of Mur-
freesboro', that I would furnish him with a history of my
surgical operations. And now, sir, in conclusion, I doubt
not you will pardon the imperfection of this hasty scrawl,
when you are informed that I never before wrote so much
at length on medical subjects as I have just done to Dr.
Avent and yourself: and that the remarks made are solely
the result of my limited experience in the premises. Please
to accept the assurance of my sincere wishes for your
welfare personally, and for the success of the enterprise in
which you are engaged. Respectfully yours,

Wm. H. Deaderick.

THE PHYSICIAN.

The following extracts are from a sermon, delivered by
Rev. Anson Smyth, occasioned by the death of Calvin Smith,
M. D., of Toledo, Ohio.

"Let the physician be a man of education, of thorough
knowledge of medical science; let him be a gentleman in
manner, and let him possess a pure moral character, and he
is qualified for such a discharge of his professional duties,
as will make him like Luke, the Evangelist, "the beloved
physician." He fills a noble, a God-like profession. It was
once practiced by the Son of God, who "went about healing
all manner of sickness amongst the people." It is a pro-
fession to which no illiterate, ignorant or vile man should
be admitted. Of the different medical theories or ]iathies I
have nothing now to say, willing for the occasion to leave
them with the divers isms of theology. But this I am ever
ready to affirm, that the miserable empiric who presumes
to practice his quackery upon the lives of his fellow men,
ought, by law, to be restrained from running at large. Of
all our temporal interests, none can, for one moment, be
compared with those which we entrust to the physician. In
his professional, social, and moral character, human welfare

394 Eclectic and Summary.

demands that he should stand above the reach of just re-
proach.

"The services which Physicians perform, claim for them
the esteem and gratitude of the world. To save life, to re-
move disease, to promote health and happiness, are the con-
stant efforts of the Faculty. When the first symptoms of
illness are perceived, our thoughts, with more than electric
speed, fly to our physician. The mere thought of our skil-
ful, faithful, and kind Doctor, dispels much of that alarm
which the occasion would prompt. He hastens to our dwel-
ling, and by timely remedies checks the incipient malady,
or perhaps, convinces us that without important aid from
medicine, nature will work her own recovery from the injury
she has received. At another time, all unexpected to us,
acute and threatening disease enters the peaceful and bless-
ed home circle — a parent or a child, some dear one is sud-
denly attacked, and at once, what agitation, what fear of a
fatal result, causes every heart to throb, and every counte-
nance to mantle with sorrow! Without delay the family
physician is summoned — he who never wants a second bid-
ding — he enters the darkened chamber, examines with care
the case, discovers the character of the disease, and admin-
isters counteracting agencies. Beside the sick one he watch-
es while danger continues; now quickening the languid
pulse, now cooling the fevered brow, and, all forgetful of his
own pillow unvisited, whispers to the patient words of
encouragement. Ere long, the stricken one walks forth in
health, and joy revisits his home. That life, to many so
precious, has been saved only by the science, skill, and fidel-
ity of him who ever after is to that household, "the beloved
physician." Do you say that such is not always the result;
that often the patient dies under medical treatment? True,
but this does not at all detract from our indebtedness to the
profession. "It is appointed unto man once to die." At some
period, earlier or later, all must sleep in death. The physi-
cian may do all that science, skill and benevolence can
accomplish, and yet death ensue. The disease may be of
so occult a character that its diagnosis shall be beyond hu-
man research. It may be so complex as to baffle all patho-
logic analysis. It may be of so virulent a type, or have made
such progress before treatment commenced, or such may be
the constitutional feebleness of the subject, that no earthly
power can save him from the grave. It may be true in some

Eclectic and Summary. 395

cases — I believe it is in many — that the physician's pre-
scriptions and advice are neglected, and death is the result
of the obstinacy or imprudence of the patient. Be the fa-
tal termination the effect of one cause or another, it is, in
more than ninety-nine cases in a hundred, wrong to impute
blame to him, who, night and day, with deep anxiety and
ceaseless effort, has battled with approaching death, and
striven to rescue the victim from its grasp. I know of no
cruelty and of no meanness, surpassing that of those who are
forever ready to blame the physician for every death that
occurs under his treatment. If he be a man of professional
ambition, if he have a sensitive and kind heart, he will deep-
ly lament the death of his patient, without the promptings
of the cold and cruel criticisms of those who know nothing,
and care nothing, for the matter whereof they affirm.

"Do you say physicians are paid for their labors, and there-
fore, the world is no more indebted to them than to mer-
chants and mechanics, who follow their callings for the
profits they afford? 1 reply that money cannot repay our
indebtedness to medical skill and achievement. You may,
however, be for a single hour in physical distress, spasms
and excruciating agonies tormenting your frail body; but
your physician hastens to your side, and administers some
quiescent preparation which at once removes your pains
and paroxysms, and restores you to health and happiness.
Will money pay for such a cure? For how much would you
remain all your life in such a state?

"Again, your precious child seems ready to fall a prey to
violent disease; but, by the skill and care of your physician,
its life is saved, its health restored. Will money pay your
indebtedness to him who brought back your dear one from
the gates of death, and placed it upon your rejoicing bosom?
Or, your own life is in danger — your weeping friends greatly
fear that you will die. Death, it may be, has for you, fears,
just and unspeakable. To your agitated soul there may be
a 'fearful looking for of judgment,' and retribution. But
through the efforts of your physician, your years are pro-
longed, your probation continued. Now, can you balance
this preservation, and salvation it may be, with dollars and
cents? The expiring English Queen, in deepest agony ex-
claimed, "Millions of money for a moment of time!"

"The physician is obliged, often, to disregard his comfort,
his health, and his life even, in ministering to the life, health,

396 Eclectic and Summary,

and comfort of others. You wake at midnight — it is densely
dark, and the cold and sweeping storm howls around your
dwelling. Upon the side- walk you hear hurried footseps, or
in the streets the rattling of carriage wheels. It is the
Doctor, driving in hot haste, to some abode of sickness.
He had after severe professional labor, just laid himself
upon his couch, which the previous night he had not visited.
Though exhausted and worn down, he hesitates not for a
moment, but hastens to the renewal of his cares and toils.
While you so quietly sleep, free from all alarms, the physi-
cian is bending over the sick, performing disagreeable du-
ties, inhaling the breath of disease, witnessing scenes of
suffering, listening to the groans of the dying. Look at
physicians in times of epidemic disease; then is apparent the
value of these noble sons of science — these heroic men who
rush to the conflict, throwing themselves before the raging
pestilence, a shield to the lives of their fellow men. Like
chivalrous brothers, or like God's angels of mercy, they fly
to the relief of suffering humanity. There is no hovel so
poor, so reeking with the deadly breath of the pestilence, or
filled with wretches so abject, that these messengers of life
refuse its calls for help. They are the life guards of human
society in all its grades. "I was sick and ye visited me."
Blessed encomium !

"Our obligations to physicians, dollars cannot cancel. And
if they could, often they do not; for how large a proportion
of their labors is gratuitous. There is no profession, no
avocation in life upon which destitution and distress make
so heavy and frequent demands. Scarce a day passes in
which they are not called upon for laborious service by those
who have no means to recompense them for what they do.
And not only are such labors without pecuniary remunera-
tion, but the condition of house and patient is often such as
to render # their performance disagreeable and self-sacrificing
in the extreme. The farmer, the merchant, and the mechan-
ic, are not expected gratuitously to supply the wants of even
the most destitute, and yet like drafts are continually made
upon the benevolence of the physician. Moreover, the
medical profession exposes the lives ot those who practice
it, to the most imminent danger. Who else is so often ex-
posed to contagious and infectious diseases? Who so liable
to be overtasked with excessive labors? In the meridian of
life, how many fall sacrifices to the health of others? And

Eclectic and Summary. 397

surely the man who performs for us such services, who sub-
jects himself to such toils, self-denials, and perils, well de-
serves the title of the "Beloved Physician." — N. J. Med. Rep.

Recommendation of Nostrums.
We commend the following to the consideration of some
distinguished professors and practitioners, whose names are
better known south and west, and who make choice of the
more common form of pill, rather than the more elegant
form of the pectoral, to dignify with certificates under their
own proper signitures. [Ed. Record.]

It is a subject of much humiliation to find physicians'
names attached to recommendations of nostrums, which
are thrown in profusion over our country. Our attention
has been again called to this matter, by reading the lauda-
tory notices of a secret combination, just now somewhat
popular, under the name of "Ayer's Cherry Pectoral." We
can hardly suppose for one moment that all the recommen-
dations of this article are genuine ; but if they are not,
there exists a strong obligation on the part of the gentle-
men whose names are used, to expose the deception, and
denounce the fraud, if not to prosecute the proprietor. We
see that in England legal redress can be had for this kind
of piracy. It ought to be so in this country, if it is not;
while at the same time every physician who willingly per-
mits his name to be used for such purposes, should be held
up to the scorn and indignation of a liberal profession. We
wish to call the attention to the recommendation of the ar-
ticle alluded to above. We do it believing that most, if
not all, the references are forged, and hope the gentlemen
will, if they have not already done so, expose the trickery;
or if they have been led astray without due reflection, that
they will at once see the impropriety of their position, and
cause their names to be withdrawn.

The names we find are — Benj. Silliman, M. D., Parker
Cleveland, M. D., and Valentine Mott, M. D., together with
many other alledged M. D's less known in the profession.

In addition to these, the "unqualified recommendation"

398 Eclectic and Summary.

of professors in the following medical schools is claimed :
Berkshire College of Medicine, at Pittsfield, Mass. ; Ohio
Medical College, Columbus, Ohio. ; Bowdoin Medical Col-
lege, Brunswick, Me. ; Vermont College of Medicine, Cas-
tleton ; Albany College of Medicine, Albany, N. Y. ;
Medical Institute, Yale College ; Transylvania University
of Medicine, Lexington, Ky. ; Medical (School, Harvard
University, Cambridge, Mass. ; Columbian Medical College,
Washington. And in foreign countries — D'Ecole de Medi-
cine, Paris, France; Royal College of Physicians and
Surgeons, London, England ; Queen's College, Ireland ;
University of Naples, Italy ; Junta of Medical Censorship
for Cuba and the Spanish West Indies ; Junta Medicale of
Chili, South America.

We know personally many of the professors in the above
colleges, who would scorn to give their names for such a
purpose, and yet they stand before the public as endorsers
of this nostrum. If some of their associates should, through
any cause, lend their names, they should be given to the
profession, and not suffer the odium to rest on the faculties
of these institutions as a whole. We can scarcely find
language to express our disapprobation of such recommen-
dations, if real, and of the fogeries if they be such. It will
give us great pleasure to publish either denials or renunci-
ations, whenever authorised to do so. The profession has
reason to expect one or the other. — Lancet.

Substitute for Mercury in Syphilis.

M. Robin lately brought before the Academy of Medicine
of Paris ten cases treated by M. Vicenti which would prove
the efficarcy of Bichromate of Potash as an anti-syphilitic
agent. From the facts, of which M. Robin gave a detailed
account, he draws the following conclusions : 1. Bichro-
mate of Potash is now ascertained to be an anti-syphilitic
agent. 2. The salt being very soluble, acts without loss
in extremely small doses, the treatment being therefore
shorter than when Mercury is used. 3. Bichromate of
Potash does not in general produce salivation. 4. The only
disadvantages hitherto noticed are nausea and vomiting

Eclectic and Summary. 399

when the salt is taken fasting ; but these unpleasant effects
do not take the place when the medicine is administered a
little time after the digestion of a meal, and especially
when it is associated with Opium. 5. It is of much use in
Neuralgia, and though it may produce asthenic effects, it is
by no means deleterious. 6- Its exciting properties may
render it useful in indolent ulcers, in more or less strong
solutions ; as also in syphilitic sore throat, in the form of
gargle. 7. As the ten patients who have taken the Bichro-
mate have not experienced the least unpleasant symptom,
even by using very large doses for a protracted period, the
new anti-syphilitic agent is now proved to be of greater
value than the Salts of Mercury, which latter may become
reduced in the economy, whilst the Bichromate is irreduci-
ble under the same circumstances, and it is so soluble as to
be easily eliminated. Two of the above mentioned cases
were treated in 1850 and 1851, and no kind of relapse has
been noticed. — Lancet.

QUACKERY.

We hope this extract from "Dr. King's Address on Quack-
ery — its Causes and Effects," which we find in the Boston
Journal— a paper that almost every issue contains some-
thing good — will be read, and that the concluding words
will by some means be placed before the public, and en-
forced on their attention.

"I must notice another cause of complaint, although it is
rather a delicate subject. I allude to the improper neigh-
borhood interference with the sick. When a person is
known to be confined by sickness, the neighbors generally
turn out to visit him ; sometimes from motives of benevo-
lence, and often from mere curiosity. A few, perhaps, will
find their way to the parlor, and others be seated in the
kitchen. Each one is big with some sage advice, which
she is very desirous to deliver herself of. One of the first
inquiries is, who is the doctor? If a visiter has herself
employed some new quack, or seen his advertisement, she
has a great curiosity to see his treatment tried, and there-

400 Eclectic and Summary.

fore insists upon bis being called ; or if her favorite is
already in attendance, she must assist him by some addi-
tional prescription of her own. Every visitor must pre-
scribe something before she will leave the premises. She
has seen just such cases before, or been in a similar condi-
tion herself, and can tell what, if anything, will cure. She
must examine the medicine, and inform the patient whether
it will agree or disagree with his constitution, and suggest
the propriety of changing the treatment if it should not cure
immediately. Every new visitor has some special advice
to give, until the patient and his friends are bewildered and
confounded ; and unless they are people of intelligence and
firmness, they are liable to be led astray. Aunt Betty and
Aunt Thankful are such good neighbors, such constant
visitors, so very kind, the patient and his friends would be
very sorry to offend them. They will certainly be very
angry if their advice is not immediately complied with.
Therefore, to please these good creatures, the prescription
of an experienced and skillful physician is thrown aside as
soon as his back is turned, because Aunt Betty don't think
it best for the patient to take such medicine, and because
she knows of something better. If the patient dies it is
because the doctor knew nothing ; if he recovers, the neigh-
bors cured him. Such measures are often caaried on so
slyly as to escape the notice of the attending physician,
and when he supposes that he alone has charge of the pa-
tient, some officious nurse or neighbor is superintendent
and prime manager, and disposes of his prescriptions and
directions as she pleases ; and when she pleases, turns him
off for whom or what she prefers. This course of pro-
ceeding not only annoys and provokes the physician, but
endangers the patient, and often renders abortive the best
medical means. It degrades the physician to a level with
the most ignorant adviser. This is a prolific fountain of
mischief that seems destined never to dry up. Its bitter
waters flow over this whole country poisoning the public
mind and quickening and nourishing the germs of quackery.
Every new pretender is careful to get into the good graces,
and makes sure of the services of some such satellites to
herald his skill and proclaim his success. This is no small
matter. It is a grave subject. The dishonor done to our
profession and the evils inflicted upon society by such
means, are incalculable. I allow that there are very few

Eclectic and Summary. 401

well bred, refined, intelligent, considerate persons who are
guilty of such conduct. I know that it is done mostly by
a class of low, thoughtless persons, who, instead of minding
their own business, undertake the care of a whole neigh-
borhood. I know that the most refined and discreet are
the less apt to meddle in such matters; and this circum-
stance, instead of helping the matter, gives the whole
business to a set of low gossips, who are always on hand
wherever they are countenanced.

To guard against all such interference, the physician
should always be careful to give all necessary directions as
to food, drink, clothing and management of every kind, so
that there may be no call for advice in any of the particu-
lars. His directions should be given with authority, and at
each returning visit he should be careful to see that every
minutia has been attended to. Every officious meddler
should be kindly but firmly rebuked, and the family of the
patient be made to understand that the directions of an at-
tending physician are not to be countermanded with impu-
nity. Let the separate provinces of the physician and the
nurse be well defined ; and if the latter is allowed to assume
the duties of the former, the physician should not be con-
tented to come in as a partner, but surrender the whole.

Another thing which does much to degrade the profession
and embarrass its members, is the universal, indiscriminate
and unlimited credit which attends the practice of many
physicians. The compensation is so meagre and so tardy,
that, physicians as a class are poor, if we except those who
have acquired property by other than professional means.
Such ought not to be the case. Every well-educated phy-
sician has made a large investment of capital in his pre-
paration for practice, and when his arduous, irksome and
responsible duties are required, the capital and those
services ought to afford him a fair and prompt remunera-
tion. In general, there can be no good reason why the bills
of physicians should not be settled as often and readily as
the bills of grocers, butchers or tailors ; and such physi-
cians as let their bills lie year after year, without presenting
them for settlement, not only injure themselves, but dis-
parage the profession generally. The public are not so
much to blame in this particular, as those physicians who
set such examples and adopt such practices ; and as the
fault is mainly our own, so the remedy is in our own hands.

402 Eclectic and Summary.

If physicians generally would set themselves to work to
correct this crying evil, by endeavoring to make regular
settlements, they would soon find themselves better off,
their services held in higher estimation, and their patients
better pleased. The physician may be sufficiently charita-
ble and indulgent, and at the same time make all reasonable
and seasonable collections ; but if he gives the public to
understand that he considers his services of little value, he
will have no reason to complain if that public adopt the
same opinion. Every practitioner should endeavor to make
his services really valuable, to satisfy his employers that
they are so, and demand a reasonable compensation for
for them. If he fails to do this, he is a poor physician. It
is notorious that a considerable share of the business of
most physicians is never paid for ; and the public appear
to think that it is the bounden duty of all physicians to go
at every beck and call, regardless of compensation, and
whoever refuses to do so is thought to be remiss in duty
and unmerciful. This mistaken notion has existed so long
that it seems to have become a settled principle in public
opinion, and at this time probably more than one fourth of
all the medical service done in New England is never paid
for at all, and some practitioners never collect one half of
their charges. Consequently many a practitioner, who has
labored hard all his life, leaves his family with little more
than a mass of unsettled accounts, which, had they been
paid as they should have been, would have made a good
estate. This condition of things is very wrong. Many
who never pay their physician, pay all other debts punctu-
ally ; and those who are absolutely unable to pay, should
be provided for by the public. Physicians are under no
more legal or moral obligations to labor for nothing, than
any other class of men ; and this the public should be made
distinctly to understand. With most other men, the eve-
ning of* a well-spent life is rendered more comfortable by
relaxation and retirement from business. The merchant or
the mechanic often retires in independence, surrounded by
all the comforts of life, to recline upon beds of down and
enjoy that repose which the infirmities of declining years
demand. Not so with the physician. The more eminent
the man, the more urgent are the calls for his services. As his
physical powers decline, his labors increase. Nothing but
a total disability is sufficient to excuse him. And when his

Eclectic and Summary. 403

trembling limbs can no longer endure fatigues, watchings
and privations, when he is literally worn out, he is given
up and set at naught ; and though he may "still live" he is
soon forgotten. Once his smile gave hope, his sadness des-
pair ; now, "none is so poor to do him reverence." He
descends to his grave unhonored and unwept. No matter
how eminent or how important have been his services. No
matter how many anxious days and sleepless nights he has
endured in the cause of humanity. No matter how many
years of unrewarded labor he has spent, standing between
his patients and their last enemy. The winds of winter pass
over him, and he is remembered no more. Not so with
clergymen and statesmen. They are venerated in life and
eulogized in death ; some friendly angel records their mer-
its in gold, and they are embalmed in history.

I know that it is much easier to complain of evils than
to find remedies for them, and I know, also, that there are
many evils which inevitably attend the profession of med-
icine, that no human effort can remove. Yet there are
some others which may be partially or entirely cured. It
is in vain to think of putting down quackery by declaring
open war against it. If you attempt to overthrow it by
reasoning, you will find your argument wasted. If you at-
tack it with invectives and sarcasm, you help to build it up
by creating a sympathy for its authors. But leave the vile
miscreants in their own filthiness, and take care to improve,
unite and build up an educated profession, and the work is
half accomplished. Nothing short of this can do it ; all
other efforts are impotent.

Much would be gained by taking measures to mark more
strongly and distinctly the line of separation between phy-
sicians and quacks, by showing the world the wide distance
between a class of educated and honorable men, and a set of
ignorant pretenders. And for this purpose, every qualified
physician should become a member of some regular medi-
cal society. This should be considered an indispensable
measure, which the interest and honor of the profession and
the safety of society imperiously demand ; and whoever,
after sufficient opportunit}', refuses or neglects to do so,
should be considered guilty of a dereliction of duty. I am
aware that there are at the present time some good prac-
titioners, who, owing to their remote location, or some
personal pique against some particular member, have

404 Eclectic and Summary,

neglected to unite with the regular society. All such
should be kindly invited to come in. On the one hand,
medical schools and medical societies should cautiously
guard against the admission of incompetent or unworthy
members, and on no account allow their established rules
to be set aside to accommodate particular cases ; and on the
other hand, all proper efforts should be made to bring in
every worthy practitioner. The barrier that separates
scientific medicine from ignorance and imposture, should be
high as the mountains and firm as adamant. It should be
apparent to all observers, that there was nothing without,
worthy of notice. When an individual assumes the high
and responsible station of physician, and receives his pro-
fessional honors, he takes upon himself obligations to the
profession and to society ; he tacitly engages to regard the
welfare of both. It is said that Hippocrates required all
those whom he instructed, first to take a solemn oath, the
principal obligations of which were to be faithful to the
sick and to sustain unblemished the honor of the profession.
The substance of that oath should be had in perpetual
recognition. Every physician should be conscious that he
is not living for himself alone, but for his profession and
for society.

There is a class of practitioners, most of them elderly
men, who appear to suppose that they have no other obli-
gations than those which begin and end with themselves.
Each pursues his own independent course, having very little
to do with medical men or medical books. Their practice
is fixed. It always was and always will be about the same
thing. They are too wise to learn, and too old to be taught
new tricks. And these are the men who make the loudest
and most doleful outcries against quacks and quackery.
Everything which disturbs the even tenor of their way is
sure to receive the tenure of their unqualified denunciation.
Now of" all men these have the least reason to complain of
quackery. They are its founders and supporters. Through
their means it has sprung up and been sustained, and they
are in a measure responsible for the whole of it. For it
was to avoid them that men had recourse to quack reme-
dies. A whole community shudders at the contemplation
of a Dr. Jalap, and to escape his clutches they fly to a Dr.
Saccharum, or anything else. If the thing ended here, it
might be of little consequence. But it is not so. Men of

Eclectic and Summary. 405

this stamp are taken for samples of the regular practice.
This is called the old mineral system, and every thing, ex-
cept some nice new quackery, is supposed to be of the same
sort. But this is a mistake. Those who suppose that there
are few or no improvements making in scientific medicine,
at the present time, and those who suppose that every new
scheme is a real improvement, are alike mistaken. Within
the last half century, medicine has certainly undergone
greater improvements than any other profession. A vast
amount of severe labor has been bestowed upon it, both in
this country and Europe. Old theories have been corrected
or exploded by physiological and pathological investiga-
tions. New remedies have been discovered, and the treat-
ment of diseases has been changed from a heroic practice to
one milder, safer and more pleasant, and I think more suc-
cessful. Whoever has been in practice for the last twenty
years, and has not been borne along by this tide of im-
provement, and made wiser and better thereby, is certainly
in the back ground and far behind the times. He has
neglected his duty to himself, to his profession and to
society, and if the public leave him where he has left him-
self, he will have no right to complain. Every supposed
improvement, from whatever source it may have originated,
has been examined and tested, and either registered and
treasured up as valuable, or discarded as worthless ; so that
the public may be well assured that whatever is ultimately-
rejected by the profession, is not worth retaining, and who-
ever pretends to possess any important medical knowledge
that is not taught in our regular medical schools, or can
not be learned from our publications, is himself an impos-
tor. — Boston Journal,

EDITOEIAL.

ADIEU.
With this number terminates the publication of "The
East Tennessee Record of Medicine and Surgery." It was
established for a specific purpose, which has not been
attained. In our zeal for the professional character of the
medical men of East Tennessee, we wished to give them a
home medium for the publication of their observations,
experience and essays ; but they have failed to avail
themselves of it. This purpose did not embrace the proba-
bility of a further pecuniary return than just a sufficiency
to meet actual expenses. With but two exceptions, our
Record has been sent to, and received, by every man, whose
name and post-office came into our possession, as practi-
tioners of medicine, in East Tennessee ; and we are happy
to say, that, with a few exceptions, the subscription price
has been promptly remitted, differing in this particular, if
their frequent appeals are correctly construed, from other
journals ; and we thereby prevented from an indebtedness
to our publishers, which otherwise would have been onerous.
The exceptions to this fact will be recognised by the indi-
viduals constituting them, if they have read thus much of
our adieu ; and if so, we hope that they will forthwith
make such remittances as will cancel all obligations, and
blot out the stain now connected with their names on our
account book.

But money is not the support of a medical journal : the
wisdom of the medical profession must be laid in no meagre
quantity upon the journal's pages, lest it will inevitably
perish. Money is the chaff, inseparable from all undertak-
ings as society is constituted, and is as necessary to thepre-
ervation of the more important elements of journalism

Editorial. 407

— imparting information and instigating "the noble emula-
tion of who can best work and best agree" — as the chaff
is essential to the perfect formation and successful preser-
vation of the grains of wheat, in which reside the life
giving qualities required by animal organisation. But
these essential elements we feel can not be commanded in
East Tennessee ; and we refer to the four numbers of this
journal to sustain us. For several months preceding the
publication of our first number we addressed letters to very
many medical men of East Tennessee, specially desiring
communications from them, because we knew that they
were in every way competent to prepare such papers, as
would not only give standing to our journal, but demand
respect from the savans of the profession, and advance the
well-being of general society. And this course of private
solicitation we have never desisted from, believing that the
principle by which the unjust of olden times was overcome,
even by a woman, was applicable to the exigency of the
time and the occasien, that forced us to labor; but with what
effect our public invitations and private solicitations have
been followed, we again refer to our pages. The result
most conclusively proves to our mind, that in East Tennes-
see, as elsewhere throughout the United States, where jour-
nals have been established and attempted to be sustained,
there are many practitioners of medicine, but few physi-
cians; many who appropriate the observations, reflections,
and labors of others, but without any attempt, however
feeble, to return the debt, by placing upon record, it may be,
at the cost of some mental and physical trouble, their own
observations and reflections. In all sincerity, we ask, is this
honest? Or, if it does not involve crime in this particular,
candidly, is it not a delinquency at least dishonorable? We
do not wish to be offensive, but duty to the vocation in which
we have spent and are spending the summer of our life, re-
quires that we should chide without fear, and suggest with-
out favor, and in the fulfilment of such requisitions, we must

408 Editorial

be permitted to state facts, and the source from which they
originate, and express the deductions to which they tend, in
just such language as seemeth to ourself to be most appro-
priate.

We have said, that in East Tennessee, as elsewhere, there
are many practitioners of medicine, but few physicians.
By this we mean that the practitioner only desires the
ephemeral influence which gives him patients from whom
he may, for services actually rendered — physically and men-
tally — receive the reward to which he is most justly entitled,
so far as they are concerned, who repose confidence in him.
But the physician, appreciating the demands of poor hu-
manity, and the united opportunities for personal observa-
tion, appropriates those made by others, and records those
made by himself, that he may, in some degree, great or
small, repay the debt he thus contracts; — impelled by the
sentiment so happily expressed by the lamented Godman,
whose memory will flourish like the green bay tree — "The
war trump and the muffled drum, and the measured tread
of armed men, and the musket-shot pealing over the grave,
honor the death of the soldier, the slaughterer of his brother
man. But the student who meets his death, battling for
truth in the great avenue of science, passes to an unknown
grave, followed by the regrets and the tears of the few who
knew his worth. Yet there is another judgment, and anoth-
er reward than that of man. A brighter glory will arise
from the obscure grave of the unknown student, than ever
yet surrounded the blood-stained monuments of the warrior
of an hundred fields." He dies bravely, besides the chris-
tian's hope, he is sustained by the proud satisfaction of hav-
ing attempted the discharge of a known duty.

We care very little for the carpings of those who express
great fears that the number of Medical Journals now in
publication will not meet with pecuniary support. If they
pay expenses and establish a single principle, perpetuate a
single new fact, or announce a new remedy, or a new appli-

cation of a well known substance, or an efficient combina-
tion, they have done well. But if they have done more — if
they have excited a proper emulation, and induced fresh
minds to communicate with their fellows, employed in the
grand effort to understand man, their conductors are entitled,
and will receive the plaudit of, "enter thou into the joys of
my Lord" — the satisfaction of a conscience void of offence
to the profession in itself, and to medical men. But make
medical journals the organs of the members of the profes-
sion, instead of mere advertising sheets — like almanacs fur-
nished by patent medicine venders — for medical schools, —
the profit being in the number of students, not in the sub-
scription list ; and induce practitioners to regard them as
instruments for their own individual use, so that Holmes' wit
may no longer be applicable — "the ring of editors sit in each
other's laps, with perfect propriety, and great convenience,
it is true, but with a wonderful saving in the article of fur-
niture;" and we feel sure that journalism will take that high
position of influence in the profession that is now wielded
by the press in political affairs — that then, in the profession,
as elsewhere, the pen will be mighty in the production of
results.

Notwithstanding the constant additions that are yearly
made to the number , of medical journals, we think there is
room for more, if established for the purposes which we have
given, as inour opinion, constitute the proper objects of such
publications; but if money is the object of the conductors
of those journals now existing, and proposed, we have no
idea that they will all meet with the support necessary to
their continued existence, setting aside altogether the ques-
tion of profit, commercially speaking.

In 1802, Dr. David Ramsey established the Charleston
Medical Register, an annual issue, and gave very cogent
reasons to sustain his views of the propriety of his publica-
tion. These referred to yearly reports, but are appropriate,
as we think, — considering the advance in every particular

410 Editorial.

that has been made since his day, — as arguments for the
support of the monthlies, bi-monthlies, and quarterlies of the
present time. We transcribe, and hope that the language
of truth, though found in an old document, will not fall still-
born upon those of this generation who may meet with
it here, and who should be affected by it.

"Medical facts, correctly stated and diligently compared
together, reflect great light on the practice of physic.
Conformable to this established principle, it must be obvious
that annual, (or more frequent) statements of the principal
events connected with the health of the inhabitants, made
by physicians in different places, would be particularly
useful. The more extensively this was done, the better ;
but in the United States the advantages of such publica-
tions are enforced by peculiar considerations. In the old
world the attention of learned men has been employed, for
many centuries, in applying the general principles of
medical science to the local peculiarities of each particular
spot. Knowledge of this kind, in America, chiefly rests
with individuals. To bring it within the reach of the
community, requires the joint labors of practitioners in
every part. If one physician, in each of the cities and
towns of the United States, and several in the country parts
of each State, were to favor the public with an annual (or
more frequent) account of the state of diseases, and of the
circumstances connected with them, as far as their obser-
vations extended, there would, in time, be an accumulation
of materials, from which we might obtain the following
advantages.

"1. More correct knowledge of the diseases of the United
States.

"2 A comparative view of the health and longevity of
the inhabitants in different places.

"3. Authentic evidences of all changes of the climate
that took place ; and particularly of the effects produced on
the health of the inhabitants from clearing and cultivating
the soil, and from the different modes and articles of culture.

"4 Persons laboring under any constitutional predisposi-
tion to particular diseases might select, with precision, a
place of residence, least likely to call into action the par-
ticular predisposition under which they labored. Such is
the extent and variety of climates in the United States, that

Editorial. 411

this might be done in almost every case, without changing
the goverment or language to which persons proposing a
change of residence were accustomed.

"5. Physicians would be enabled to direct invalids to
such a route in travelling as would best suit their particu-
lar habits and diseases. From the want of this local
knowledge, improper advice is frequently given. The lon-
gitude and latitude of places afford no certain rule. Their
influence, controled by a variety of local circumstances,
is by no means uniform.

"The advantages of the proposed annual publications,
would not be confined to the medical department. Th$ far-
mer and gardener, from an average of seasons, would be
assisted in forming their opinion of the best time for their
respective operations.

"The enterprising agriculturist, who wished to enrich his
country with some new productions, would be informed
when and where to make his experiments, by comparing the
observations auxiliary to the practice of physic, with the
usual habits of the particular commodity he wished to in-
troduce.

"A facility might thus be given to the introduction of gin-
ger, japan sago, of the almond, allspice, caper, clove, cinna-
mon, camphor, nutmeg, red cotton trees, and several other
valuable exotics. There are, doubtless portions of the United
States suitable to the culture of these articles; but that suit-
ableness is unknown to foreigners, and equally so to the
owners of the soil. The same observation applies to the
introduction of new animals, and of new branches of man-
ufacture. Success, in both cases, must be materially influ-
enced by the degree of heat and cold, and of the moisture
and dryness of the atmosphere.

"The foreigner who wished to remove to this land of equal
rights, would also be enabled to determine where to locate
himself in a situation least variant from his trans atlantic
residence."

We are done; but we hope, indeed we feel, that our labor
will not be lost upon those w r ho have helped us to sustain
this publication. Our name is now connected with the edi-
torial department of "The Southern Journal of the Medical
and Physical Sciences," published at Nashville; and we
most earnestly invite and solicit the members of the Medi-

412 Editorial.

cal profession, and other gentlemen of Science, with whom
we have been conversing through the pages of the Record,
to become subscribers and contributors to that journal —
that we may in its perpetuation and character, build up at
Nashville, a monument as creditable to the minds of the
workmen, and as beneficial to posterity, as the capital build-
ings are magnificent in architectural design, and in work-
manship as ending as time. Let it be the work of Tennes- *
seeans — native or adopted — and amongst them let not those
who labor in East Tennessee be found to be the workmen
most tardy. We pray them endeavor
"Be ye heroes in the strife."
And now we return our most profound thanks to the edi-
tors of the Medical journals, who so freely extended to us
the right hand of fellowship, and their commendation. We
are sorry to part with you, but our pecuniary means do not
permit us to ask that your welcome sheets shall continue to
greet us; we can hardly tell how to get on without them,

but "charity covereth a multitude of sins," and our

address is yet, "The Record."

ETHICS.

"There is no profession, from the members of which great-
er purity of character, and a higher standard of moral
excellence are required than the medical." — Ethics of the
American Medical Association.

We are very much disposed to cavil at the iutroduction
into the above quotation of the words "are required." The
connection in which they are placed, is an evidence of that
unsophisticated habit of mind, which prevails alone with
those of reasoning faculties, who are honest in purpose as
well as in detail ; and we, therefore, have nothing to say,
that will in any maner, direct or remote, assail the motives
or labors of the framers of the ethics by which we as an

Editorial 413

individual profess to be governed. But we do most posi-
tively protest against the use of the words which we have
signalised and italicised so far as they apply to the demands
of the public in general — the source from which the mem-
bers of the profession derive their support.

From our own personal knowledge, and we have not
hesitated, on any occasion to state facts supporting our
position, whether as the humble conductor of a med-
ical periodical, published in an inland locality, or as
filling, in a subordinate capacity, the more dignified posi-
tion of member of the "American Medical Association," to
state facts supporting the position, which we again distinct-
ly and most unequivocally take in this article.

"At present neither purity of character, moral excellence,
nor professional attainments are required, by the gen-
eral public, from medical men ; but, for the most part, a
simple complianbe with the ordinary views of general so-
ciety — assuming much and successfully playing upon the
assumption for the promotion of private ends, will give
satisfaction."

We know that, ordinarily, the practitioner best qualified
meets with an acknowledgment of his meritoriousness,
fully equivalent to all he deserves, if the comparison is in-
stituted between the demands of his profession in itself;
but if the reward is adjudged from a consideration of the
"requirements" of the general public, those most meritori-
ously entitled to confidence as physicians, will receive but
a very limited pecuniary return for the actual physical
and mental labor which the have expended, to say nothing
whatever about positive monetary outlay.

If regarded as applying alone to the demands of the pro-
fession, we will enter no opinion contrary to the very words
of the quotation which we have made. But if, as we
believe, the code of ethics was adopted for the purpose of
destroying imposition and establishing a proper correspon-
dence between medical men and those who, by necessity,

414 Editorial.

are forced to employ the unfortunate individuals who have
assumed the responsibilities of the physician, we must be
permitted to say that the ethics — however progressive the
age may seem to be — are as far ahead of the times
in which they are published, as Swedenborg's, astro-
nomical, anatomical and general scientific assertions —
making no allusions to his illumination — were in advance
of the age in which they were enunciated. And we
know too, that this assertion will be appreciated by
but few, either out of, or in the profession ; because we
feel that but few pay any attention, be personal pro-
fessions to the contrary what they may, to general princi-
ples. We know that in our private intercourse — and we
hope that our intimate association will be esteemed to be
with men of intelligence — our very frequent allusions to
general principles is a pivot on which turns an occasional
jest, not from any want of confidence in the universal ap-
plicability of general principles, but from an intimate ac-
quaintance with the almost uniform disregard that they
receive from men, and the equally ordinary respect that is
obsequiously rendered to that which is most euphoniously,
in its common acceptation, called policy, but, which, under
the same circumstances of construction, with men of sut-
tle integrity, and fully familiar with general principles, is
but a softer name for dishonesty. An acquaintance with
general principles, in connection with a disposition to ap-
preciate them and pay them practical respect, necessarily
involves correctness of deportment in special and particu-
lar cases. But this is an age of specialities — in morals, law,
religion, medicine, social and commercial, and all the other
relations sustained by men ; and but few, comparatively,
take into consideration the philosophy of motive and the
objects of association. The whole world is rampant in
denunciations against the use, because of the abuse of the
various preparations of alcohol, and forgetting the injunc-
tion of the apostle, to "touch not, taste not, handle not,

Editorial. 415

which all are to perish with the using, after the command-
ments and doctrines of men," is becoming "subject to
ordinances." And yet the very vices, so [positively and
pointedly deprecated by the language of the book of books,
and condemned by the Jaws of the land, are daily practiced
with a most unblushing effrontery, and without any fear of
reproach, except in the weakly homilies delivered in form
from the pulpits of various denominations of christians,
which fall, for the most part, upon minds revolving other
matters, mayhap the skill of the last manoeuvre in trade,
or the weak points of a pigeon yet to be plucked, the beauty
of a particular trick to practice at the gaming table, the
excitement of the last commitment of fornication, or the
formation or combination of words with which to traduce
the character, defame the reputation and destroy the com-
fort of some individual who is necessarily or unwittingly
an opponent. This is a fair illustration of the position
which we regard the people of the more civilized (so
yclept) portion of the world as being in at this present age.
But if another is wanting, we refer to the great variety
of denominations of professed christians, all originating in
an attention to special propositions, which wholly destroys
the potency of the virtue intrinsically possessed by the gen-
eral principles, which all the various names of christian
associations attempt to inculcate and pretend to practice.
And yet who can say /that in this age of light and liberty,
when the great moral energy is directed against idolatry and
drunkenness, that the crimes of hatred, variance, emula-
tions, wrath, strife, &c, are not most fearfully prevalent.
The general principles of the whole word of God are
swallowed up in the practice of one or two virtues, and the
denunciations of one or two vices ; and if this is true, in
general society, its members do not require, any essential
purity of character and moral excellence from the mem-
bers of the medical profession — the only requirement is a
tame submission or active compliance with the behests,

416 Editorial

which that society has conventionally made virtues.

We have thus expressed ourselves, because we think that
the members of the medical profession are, for the most
part, (we of course speak of the aggregate,) too prone to
use the circumstances of worldly policy, to advance them-
selves in their professional individuality, making a "show of
wisdom in will-worship, and humanity, and neglecting of
the body ; not in honor to the satisfying of the flesh."

The demands of the profession of medicine certainly are
as strong as the wise compilers of our ethics have express-
ed; but the strength of expression and the demands, are
alike disregarded, and will be, until men in general so-
ciety (and with the same unanimity of opinion as they now
regard the drunkard) consider the slanderer, the revengeful,
and envious, equally despicable.

The demands of the profession being so great, and the
circumstances so positive against the probabilities of gene-
ral society permitting a compliance with those demands, we
again as in previous numbers of our humble Record, call
upon the great Congress of the American Medical Repub-
lic, to enter the arena of general reform, making that of our
profession incidental, and in the power of its congregated
wisdom, to eschew any special pleading, and enunciate
alone, reiterated ly, and therefore efficiently, general prin-
ciples of Ethics.

We are in no way connected with the pecuniary affairs
of the Southern Medical and Physical Journal, but are au-
thorised to receive subscriptions. And as we like to com-
municate with our brethren of the profession, and expect to
give our time in a measure, to the interests of that journal,
we solicit subscriptions, and most anxiously hope to receive
communications from the practitioners of East Tennessee*

COUNT WAY LIBRARY OF MEDICINE

RARE BOOKS DEPARTMENT

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